This version of the policy will become effective on 09/11/2022.
AIM Specialty Health® (AIM) has revised their Clinical Appropriateness Guidelines for Musculoskeletal. For a detailed summary of changes, see the specific guidelines which will become effective 09/11/2022. These guidelines are available online at: http://www.aimspecialtyhealth.com/CG-Musculoskeletal.html.
The following CPT code has been added to Attachment B of this policy as Medically Necessary:27345: Excision of synovial cyst of popliteal space (eg, Baker's cyst)
AIM Specialty Health® (AIM) will utilize Medicare guidelines (e.g., Local Coverage Determinations [LCD], National Coverage Determinations [NCD]) or in the absence of a specific Medicare guideline, AIM will utilize their Clinical Appropriateness Guidelines to determine medical necessity for the following procedures: