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AIM Makes Enhancements to Its Clinical Appropriateness Guidelines for Radiology and Cardiology

On April 21, 2014, AIM Specialty Health® (AIM) made enhancements to their clinical appropriateness guidelines for radiology and cardiology.  A summary of these enhancements is provided below: 

MRI and CT Upper and Lower Extremity 

  • Recent changes to MRI and CT of the upper and lower extremity for conservative therapy (e.g., physician-supervised physical therapy, medications and rest) prompted very useful feedback from health plan medical directors and the provider community.  Based upon this feedback, the requirement for physician-supervised physical therapy prior to imaging was removed from the following indications as of April 21, 2014:
    • Ligament and tendon injuries
    • Epicondylitis
    • Persistent lower extremity pain (excluding the knee joint)
    • Acute and chronic tendon injuries – foot and ankle


  • For chondromalacia patella, the conservative treatment timeframe criteria will be reduced from 12 weeks to four weeks


  • In addition, the imaging indication of hemarthrosis will be modified to include instances when arthrocentesis may be contraindicated (e.g., nontraumatic causes of hemarthrosis such as sickle cell, anticoagulant, or hemophilia).


Transcatheter Aortic Valve Implantation / Replacement (TAVI / TAVR) 

Transcatheter aortic valve implantation (TAVI), also known as transcatheter aortic valve replacement (TAVR), has emerged as an alternative to traditional aortic valve replacement in some subgroups of patients with aortic stenosis.  In preparation for the TAVI/TAVR procedure, it is important to examine the aortic root in order to properly size the aortic valve prosthesis.  It is also necessary to evaluate the aorta itself, as well as the femoral and Iliac arteries, to be sure there is a clear pathway for the catheters necessary to do the procedure. 

The following guidelines were modified to add an indication for the evaluation of the aortic root and aortic, iliac, and femoral vessels in patients undergoing evaluation for TAVI / TAVR:

  • Cardiac CT (cardiac structure)
  • Cardiac MRI
  • CTA/MRA of the chest
  • CTA/MRA of the abdomen
  • CTA/MRA of the pelvis
  • CT of the chest
  • CT of the abdomen
  • CT of the pelvis

If you have any questions regarding these enhancements, please contact AIM directly at  Click here to access and download a copy of AIM’s current clinical appropriateness guidelines.