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CLINICAL APPROPRIATENESS GUIDELINES

8600 West Bryn Mawr Avenue South Tower Suite 800 Chicago, IL 60631 2017 Effective Date: 09/01/2022 Version Creation Date: 09/01/2022 Approval and implementation dates for specific health plans may vary. Please consult the applicable health plan for more details. AIM Specialty Health disclaims any responsibility for the completeness or accuracy of the information contained herein. CLINICAL APPROPRIATENESS GUIDELINES ADVANCED IMAGING Appropriate Use Criteria: Oncologic Imaging Proprietary 2022 AIM Specialty Health. All rights reserved. Oncologic Imaging 2022 AIM Specialty Health. All rights reserved. 2 Table of Contents Description and Appli cation of the GUIDELINES ..4 General Clini cal Guideline ..5 CLINICAL Approp riateness Simultaneous Ordering of multiple Diagnostic or Therapeutic Interventions ..5 Repeat Diagnostic Repeat Therapeutic Oncologic Imaging ..7 General Technology Considerations.

the “Guidelines”) are designed to assist providers in making the most appropriate treatment decision for a specific clinical condition for an individual. As used by AIM, the Guidelines establish objective and evidence-based criteria for medical necessity determinations where possible. In the process, multiple functions are accomplished:

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Transcription of CLINICAL APPROPRIATENESS GUIDELINES