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Medical Policy and Coding Updates - June 2021
Premera Blue Cross·WA, AK · Orthopedics, Neurology, Radiology +4 more·Medical Policy
Effective date
Sep 12, 2021
We identified it
Jun 18, 2026
Summary
AIM Specialty Health updated clinical appropriateness guidelines for advanced imaging (spine, extremity, vascular) with new requirements for radiographs, conservative management durations, and limited CT use. Multiple new drug policies were added for rare diseases, hormone therapies, and other conditions.
Action Required
By September 12, 2021: Billing and prior authorization teams must update workflows to comply with new AIM Specialty Health guidelines. Ensure radiographs are obtained before advanced imaging for spine conditions like scoliosis and axial spondyloarthropathy. Verify extended conservative management periods are documented for extremity conditions (chronic meniscal tears, anterior knee pain, plantar fasciitis). Update prior authorization requests to include new clinical criteria for MS diagnosis, spinal infections, and extremity conditions. Train providers on revised imaging strategies that limit CT use when MRI is available.