In March, AIM Specialty Health^® to update clinical guidelines for prostate cancer imaging

Starting March 13, 2022, AIM Specialty Health will publish updated oncologic imaging clinical guidelines for prostate cancer to include indications for 18FDCFPyL (piflufolastat injection or Pylarify^®) PET/CT imaging (radiology procedure code *78815).

In the future, these scans will be available for you to select when you submit prior authorizations requests to AIM.

Until you are able to select these scans, use the “free text” field in the prior authorization request and:

• Enter “PET w/ Pylarify, tumor stage and prior treatment (prostatectomy and/or radiation)”
• List the conventional imaging that has been completed (MRI prostate/pelvis, CT or bone scan) and the results of those procedures

This applies to the following members:

• Blue Cross commercial
• Medicare Plus Blue^SM
• Blue Care Network commercial
• BCN Advantage^SM

Where to find AIM's clinical guidelines

You can find AIM's clinical guidelines for oncologic management at aimspecialtyhealth.com/**. Open the Radiology Guidelines webpage and search for “Oncologic Imaging.” Then scroll to find the Prostate Cancer guidelines.

Submitting prior authorization requests

Submit prior authorization requests to AIM. For information on how to submit requests and for other resources, visit these webpages on our ereferrals.bcbsm.com website:

• Blue Cross AIM-Managed Procedures
• BCN AIM-Managed Procedures

*CPT Copyright 2020 American Medical Association. All rights reserved. CPT^® is a registered trademark of the American Medical Association.

**Clicking this link means you’re leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. While we recommend this site, we’re not responsible for its content.

Posted: December 2021
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network