anthem ultrasound coverageidioms about being sneaky

Updated Coding section with 10/01/2022 ICD-10-CM changes; added O35.00X0-O35.9XX9 replacing O35.0XX0-O35.9XX9. Prostate Cancer (V1.2023). While some trials using HIFU to treat pancreatic or liver cancer have shown some promising results, these trials have lacked a comparator group (Chen, 2015; Dupr, 2015; Shi, 2015; Sofuni, 2014). Int J Clin Pract. Updated June 13, 2019. Locally recurrent prostate cancer after initial radiation therapy: early salvage high-intensity focused ultrasound improves oncologic outcomes. HIP Maternity will cover enhanced benefits . This document does not address nuchal translucency. Ultrasound Tech in San Antonio, Texas, United States. The routine use of pulsed Doppler ultrasound to either document or listen to embryonic/fetal cardiac activity is discouraged. 2011; 108(8 Pt 2):E196-E201. Reviewed and validity confirmed 2011. By March 2018, Anthem (Blue Cross/Blue Shield) will require that MR and CT scans considered "not medically necessary" be performed at freestanding medical imaging facilities in order to be covered. Rockville (MD): Agency for Healthcare Research and Quality (US); 2020 Sep. Report No. HAIFA, Israel - MIAMI, Florida (December 22, 2022) Insightec , a global healthcare company dedicated to using acoustic energy to transform patient care, announced today that Anthem is the third national payor to cover MR-guided Focused Ultrasound for treating medication-refractory Essential Tremor. AIUM Practice Parameter for the Performance of Limited Obstetric Ultrasound Examinations by Advanced Clinical Providers. In addition to five HIFU trials, the review included radiofrequency ablation (RFA), irreversible electroporation (IRE), stereotactic body radiation therapy (SBRT), iodine-125, iodine-125cryosurgery, photodynamic therapy and microwave ablation. Siddiqui KM, Billia M, Arifin A, et al. CO CHEIBA Custom Blue Priority PPO/BluePreferred Plan F 01 -20 1 of 15 Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2021- 12/31/2021 Anthem Blue Cross and Blue Shield: Prime Blue Priority PPO Int J Gynaecol Obstet. While the analysis showed superior survival rates at 6 and 12 months in the groups which included HIFU in combination therapy, the authors noted that the overall quality of the studies was poor. 2021. . We reserve the right to review and update Clinical UM Guidelines periodically. (2018). 2013; 48(6):351-358. 2017; 71(2):267-273. CA/IND/Anthem Silver 94 HMO/657X/01-22 Page 1 of 11 Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered ServicesCoverage Period: 01/01/2022 - 12/31/2022 Anthem BlueCross Coverage for: Individual + Family | Plan Type: HMO Anthem Silver 94 HMO The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. 2007; 51(2):381-387. Uchida T, Baba S, Irie A, et al. November 17, 2019. Matthew Thornton Health Plan, Inc./Anthem Blue Cross and Blue Shield Coverage for: Individual + Family | Plan Type: HMO Anthem Silver Pathway X Enhanced HMO 5500/20% S05 ($0 Preferred Virtual Care + $0 Select Drugs) The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. J Urol. 2021: S1078-1439(21)00173-3. 2014; 114(4):532-540. Birth Defects Homepage: Diagnosis. July 25, 2018. The gestational sac is examined for the presence of yolk sac and embryo/fetus (a fetus is generally defined as greater than or equal to 10 weeks gestational age). 2014; 84(5):1157-1162. Accessed on October 20, 2022. American College of Obstetricians and Gynecologists (ACOG). These options carry their own risks and side effects. Prostate cancer therapy with high-intensity focused ultrasound. Of note, 65.7% (23/35) of individuals in the placebo group did not complete the 3-month follow-up compared to approximately 21% (26/112) of the MRgFUS group. Assess vaginal bleeding of undetermined etiology; Assess abdominal or pelvic pain of undetermined etiology; Evaluation of fetal condition in late registrants for prenatal care; History of unexplained fetal demise in a previous pregnancy; Assess the fetus in cases with maternal risk factors such as family history of congenital abnormalities, chronic systemic disease (including but not limited to, hypertension, diabetes or sickle cell disease), preeclampsia, substance abuse or hyperemesis gravidarum; Assessment of fetus after abnormal serum Alpha Fetal Protein (AFP), serum screen or multiple analyte serum screen, or cell-free fetal deoxyribonucleic acid (DNA) screening for aneuploidy; Suspected ectopic pregnancy or hydatidiform mole, and to follow hydatidiform mole; Assess the fetus in cases of Rhesus (Rh) isoimmunization and other causes of fetal hydrops; Provide guidance for other testing, such as amniocentesis, chorionic villus sampling, and cordocentesis or procedures such as intrauterine blood transfusions or other in-utero fetal therapeutic procedures. There are a number of uncontrolled case series and prospective studies which address HIFU for prostate cancer (Ahmed, 2009, 2011, 2012; Beerlage, 1999b; Blana, 2004; Chaussy, 2001; Gelet, 2000; Gelet, 2004; Guillaumier; 2018; Lawrentschuk, 2011; Muto, 2008; Napoli, 2013; Poissonnier, 2007; Shoji, 2010; Thuroff, 2003; Uchida, 2002; Uchida, 2005; Uchida, 2006a; Uchida, 2006b; Zacharakis, 2008). AIUM practice guideline for the performance of obstetric ultrasound examinations. Curr Urol Rep. 2003; 4(3):248-252. Rebillard X, Gelet A, Davin JL, et al. A set of individuals who were positive for insignificant disease at 12 months (n=4) or clinically significant disease at 12 months (n=5) required salvage treatment. Pain severity was further reduced at the 3-month follow-up to 1 (SD 1.1) (0-3; 95% CI, 0-1.85) (p=0.001). Lawrentschuk N, Finelli A, Van der Kwast TH, et al. P110039. CA/LG/Anthem PPO HSA/H 2000/3000/4000 20/40/73A3/01-23 Page 1 of 11 Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Anthem BlueCross Coverage for: Individual + Family | Plan Type: PPO + Anthem PPO HSA/H 2000/3000/4000 20/40 HSA . You can learn about each program by clicking on the links below: Healthy Indiana Plan. Addition of cell-free fetal deoxyribonucleic acid (DNA) screening for aneuploidy to Medically Necessary Statement. Cochrane Database Syst Rev. check_circle Item Saved! Cancer. Added not medically necessary statement for TULSA. First trimester ultrasound tests alone or in combination with first trimester serum tests for Down's syndrome screening. Step 2: After you become pregnant, you will join HIP Maternity. Napoli A, Anzidei M, De Nunzio C, et al. A total of 22 individuals participated in the follow-up. Prostate cancer is the most commonly diagnosed cancer in men, accounting for 19% of all new cancer cases. Eur Urol. TULSA is considered not medically necessary for any indication, including but not limited to prostate cancer. There were no new reported serious AEs. Ultrasound Obstet Gynecol. Ultrasound is currently being used as a therapeutic treatment, for example, lithotripsy to disintegrate kidney stones. The bone metastases arose from a variety of primary tumors including renal, colorectal, lung, breast and prostate. Moved content of MED.00119 High Intensity Focused Ultrasound (HIFU) for Oncologic Indications to new clinical utilization management guideline document with the same title. 2003; 17(8):673-677. Crouzet and colleagues (2014) conducted a large prospective case series (n=1002) to evaluate rates of survival and morbidity over the long term in subjects treated with HIFU (Ablatherm) for localized disease. The majority of attributable AEs were grade 1 or 2. Bone metastasis: When cancer cells have broken off from the primary tumor and have settled and started growing on bones. After excluding the drop-out groups the results remained similarly statistically significant. In 2012, the FDA approved via the Premarket Application (PMA) process, the ExAblate System (InSightec, Ltd, Dallas, TX) for pain palliation in individuals 18 years and older who have metastatic bone cancer pain and have failed, are not candidates for or have refused standard radiation therapy. BJU Int. Anthem Member Services 1-855-690-7784 (TTY 711) Monday through Friday, 7 a.m. to 7 p.m. Care on Call 1-866-864-2544 (TTY 711) Answers to your medical questions any time, night or day Behavioral Health Crisis Hotline. 2017; 120(2):246-256. The remaining 11.1% (2/18) reported pain reoccurrence which required pharmacological care. ACOG Practice Bulletin Number 229. We are now accepting all Anthem Blue Cross Blue Shield patients. Prostate Cancer. CT, digital radiography, ultrasound, mammography and DEXA equipment at each of our outpatient centers. Transrectal high-intensity focused ultrasound for treatment of patients with stage T1b-2n0m0 localized prostate cancer: a preliminary report. 2010; 468(10):2825-2827. 2012; 105(2):198-202. Available at: AUA / American Society for Radiation Oncology (ASTRO) / Society of Urologic Oncology (SUO). Updated References section. Due to variances in utilization patterns, each plan may choose whether to adopt a particular Clinical UM Guideline. Shah TT, Peters M, Kanthabalan A, et al. Available at: Limited obstetrical ultrasound examination. Colombel M, Gelet A. Placenta Accreta Spectrum. Alternatively, commercial or FEP plans or lines of business which determine there is not a need to adopt the guideline to review services generally across all providers delivering services to Plans or line of businesss members may instead use the clinical guideline for provider education and/or to review the medical necessity of services for any provider who has been notified that his/her/its claims will be reviewed for medical necessity due to billing practices or claims that are not consistent with other providers, in terms of frequency or in some other manner. Available at: Second and third trimester screening for fetal anomaly. Eur Urology. 2017; 119(6):896-904. Cochrane Database Syst Rev. However, EBRT has been shown to be ineffective in approximately 20-30% of cases and pain recurs in 27% of the treated population (Liberman, 2009). Sonablate was classified as a class II device. Klotz L, Pavlovich CP, Chin J, et al. Results indicated that median survival in RFA, IRE and SBRT was more favorable compared to HIFU. For more information about your rights, look at the explanation of benefits you will receive for that medical claim. Available at: High Intensity Ultrasound System For Prostate Tissue Ablation (Focal One). Single high intensity focused ultrasound session as a whole gland primary treatment for clinically localized prostate cancer: 10-year outcomes. 1999a; 54(2):273-277. J Endourol. NCCN Clinical Practice Guidelines in Oncology. . * From Jawad MU, Scully SP. Although the exact mechanism of analgesic action of MRgFUS in pain palliation is unknown, studies have pointed to a few explanations. 2018; 51(4):463-469. July 23, 2021. Updated Coding section with 10/01/2020 ICD-10-CM changes; added O99.891; removed Q51.20 deleted 09/30/2020. Hoosier Healthwise. Insurance coverage for whole-breast ultrasound is evolving. Medicare Supplement Plan F is great because it provides the most coverage of the 10 currently available MedSup plans. Temperatures within the targeted area increase to 60-95C, which destroys the targeted tissue without damaging the adjacent tissue. Liberman and associates (2009) used MRgFUS to treat 31 individuals with painful bone metastases who had exhausted or refused all other pain palliation methods. At 2 weeks follow-up, all individuals experienced a decrease in VAS pain scores from baseline (1.5-5). HIFU is a non-invasive ablative procedure which has the advantage of sparing surrounding tissue which may reduce postoperative morbidity and hasten recovery. First clinical experience of intra-operative high intensity focused ultrasound in patients with colorectal liver metastases: a phase I-IIa study. We have 53 properties for rent listed as: house bury, from 520.Find: bury properties for rent at the best prices We use cookies to personalize your Trovit experience on our site, analyze. Previously, CDC recommended serial ultrasounds every 3-4 weeks for women with laboratory evidence of Zika virus infection based on existing fetal growth monitoring for other maternal conditions (e.g., hypertension or diabetes). MedlinePlus. Updated Coding, Description, Discussion/General Information, and References. Taneja SS. When services are Not Medically Necessary:For the procedure and diagnosis codes listed above when criteria are not met or for all other diagnoses not listed; or when the code describes a procedure or situation designated in the Clinical Indications section as not medically necessary. High intensity focused ultrasound ablation for patients with inoperable liver cancer. Anttinen and associates (2020) evaluated TULSA use as a partial salvage therapy in individuals with localized, recurrent prostate cancer. The majority of events were minor and reversible. It is completely automated and therefore extremely rigid. This study was defined by the regulatory agency to evaluate the effectiveness of the device to ablate prostate tissue. When high-intensity ultrasound waves are used in place of low-intensity, body tissue absorbs, rather than reflects the energy. Last Revised March 16, 2022. CA/IND/Anthem Silver 73 HMO/657G/01-22 Page 1 of 12 Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered ServicesCoverage Period: 01/01/2022 - 12/31/2022 Anthem BlueCross Coverage for: Individual + Family | Plan Type: HMO Anthem Silver 73 HMO The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. As of January 10, 2022, through January 31, 2022, Anthem and its delegated entities will suspend select prior authorization requirements to allow healthcare providers to focus on caring for patients diagnosed with COVID-19. Government Agency, Medical Society, and Other Authoritative Publications: The use of specific product names is illustrative only. Eur Urol. Updated Discussion, References and Websites for Additional Information sections. Due to variances in utilization patterns, each plan may choose whether to adopt a particular Clinical UM Guideline. Updated Coding section; corrected ICD-10 diagnosis code O41.00X0. Ahhhhh! The pain severity score was significantly reduced from a baseline mean of 7.1 (Standard Deviation[SD] 2.08) (4-10; 95% confidence interval [CI], 6.07-8.15), to 2.5 (SD 1.4) (0-5; 95% CI, 1.81-3.2) at 1 month. Updated Discussion/General Information, Coding and Reference sections. Effects of high-intensity focused ultrasound for treatment of abdominal lymph node metastasis from gastric cancer. Elterman D, Li W, Hatiboglu G, et al. Rischmann P, Gelet A, Riche B, et al. 2014; 96(9):743-751. Anthem - Blue Cross Blue Shield Long awaited and much anticipated? Federal and State law, as well as contract language, and Medical Policy take precedence over Clinical UM Guidelines. 2015; 194(1):114. PSA nadir as a predictive factor for biochemical disease-free survival and overall survival following whole-gland salvage HIFU following radiotherapy failure. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member. MRI-TULSA resulted in an 88% reduction of viable prostate tissue volume. Grade 3 (n=1) and grade 2 (n=3) AEs related to urinary retention and urinary tract infection were reported. 2011; 3(3):329-338. Joo B, Park MS, Lee SH, et al. 2006b; 97(1):56-61. Chin JL, Billia M, Relle J, et al. FAQ 133, July 2021. Replaced term women with individual within clinical indications. Influence of high intensity focused ultrasound (HIFU) treatment to the pancreatic function in pancreatic cancer patients. No. Cochrane Database Syst Rev. Our radiologists are among the most . Participants were followed for up to 5 years post-procedure. American College of Obstetricians and Gynecologists (ACOG). Guidelines for diagnostic imaging during pregnancy and lactation. In addition, 21% of individuals in the MRgFUS group reduced their morphine equivalent daily dose (MEDD) intake and another 26% completely stopped their MEDD consumption. 2004; 7(4):289-294. Pain palliation in patients with bone metastases using magnetic resonance-guided focused ultrasound with conformal bone system: a preliminary report. While there is no reliable evidence to support ultrasounds performed during pregnancy will harm a fetus, there is general agreement that the casual use of ultrasonography during pregnancy should be avoided (ACOG, 2018). Summary of Safety and Effectiveness Data (SSED). The study also included a crossover component; 17 of the 23 individuals in the placebo group who did not complete follow-up chose to receive rescue MRgFUS after a lack of response to placebo. The primary endpoint was achieved in 96% (110/115) of participants. J Urol. MPTAC review. A multicentre study of 5-year outcomes following focal therapy in treating clinically significant nonmetastatic prostate cancer. Br J Cancer. The focus of this study was the use of prostate specific antigen (PSA) as a predictor of disease-free survival after HIFU, not the outcomes related to HIFU treatment. Updated References and Websites for additional information sections. When an embryo/fetus is detected, it should be measured, and the cardiac activity should be recorded by 2-D video clip or M-mode. J Ultrasound Med. In addition, eligible participants reported a numerical rating scale (NRS) pain score of 4 or greater in spite of maximal pain medication therapy, and a score of 7 or less on the Mirels fracture risk scale. J Bone Joint Surg Am. 2022 Prenatal ultrasound diagnosis (Dx) codes Please note that this information is a guideline. Summary of coverage and benefits PDF Service coverage and costs All employee health insurance plans provide one annual preventive care visit with your primary care provider at $0 co-pay within specified networks. Following treatment, no residual tumor was found in 46.2% of cases. The authors concluded, Although newer modalities hold promise, we need higher quality studies to assess patient important outcomes to guide evidence-based clinical practice.. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise, without permission from the health plan. Salvage high-intensity focused ultrasound for patients with recurrent prostate cancer after brachytherapy. The system protects the urethra and rectum via a water cooling system pumped through the applicator. You bet! Updated Coding section to include ICD-10-CM diagnosis codes Z36.0-Z36.9. Focal salvage therapy for localized prostate cancer recurrence after external beam radiotherapy: a pilot study. MPTAC review. 2012; 118(12):3071-3078. Anthem has stopped covering patients in nine states 1 for MRI and CT scans performed in hospital outpatient settings - unless the exam qualifies for an "exception." On Nov. 15, Anthem will start retroactive reviews of MRI and/or CT services done in emergency departments in Missouri, Ohio and Kentucky. Anthem has begun denying coverage for . National Coverage Determination: Ultrasound diagnostic procedures. ACOG Practice Bulletin 175. Step 1: Report your pregnancy to your health plan. High-intensity focused ultrasound (HIFU) followed after one to two weeks by radical retropubic prostatectomy: results of a prospective study. Harding D, Giles SL, Brown MRD, et al. Systematic review of high-intensity focused ultrasound ablation in the treatment of breast cancer. Anthem BlueCross Coverage for: Individual + Family | Plan Type: HMO Anthem Value Ded HMO 750/25/40/25% The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Rooms for rent in Bury flat and house shares - 3 currently available. Zip Code or City, State . The Centers for Medicare and Medicaid Services (CMS) released an updated Relative Value file Jan. 5, that includes updated reimbursement for the neuromuscular ultrasound codes 76881, 76882 and 76883. Local recurrence of prostate cancer after external beam radiotherapy: early experience of salvage therapy using high-intensity focused ultrasonography. $0 virtual care, 24/7. HIFU or MRgFUS has also been studied as a potential treatment of various cancers. Gelet A, Chapelon JY, Bouvier R, et al. Researchers used the visual analog pain score (VAS) to measure pain levels. The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Muto S, Yoshii T, Saito K, et al. Thompson I, Thrasher JB, Aus G, et al. An abnormal finding on second-trimester ultrasonography that identifies a major congenital anomaly significantly increases the risk of genetic abnormality and warrants further counseling, including the discussion of various prenatal testing strategies. Rejection notice to me (if I'm lucky) and I start over. Management of preterm labor. The uterus, cervix, adnexa, and cul-de-sac region should be examined. Anthem becomes the third national payor to cover the treatment after Aetna and Blue Cross Blue Shield Association gave it positive coverage decisions in April 2021 and August 2018,. Added medically necessary indication when there is a known or suspected exposure to the Zika virus to the Clinical Indications section. The NCCN Prostate Cancer CPG (V1.2023) includes a recommendation for individuals with tumor recurrence following radiation therapy to include HIFU as a treatment option (2B recommendation). The authors noted these results compared well to the radiation therapy complication rate. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise, without permission from the health plan. Yonsei Med J. A total of 29 individuals underwent a follow-up biopsy, either at 12 months only, or at 12 and 36 months. Indiana Medicaid for Members. 2015; 62(137):140-143. Updated Discussion/General Information and Reference sections. The overall survival (OS) rate was 80%, the progression-free survival (PFS) rate was 94%, and the disease-specific survival rate was 97%. Ahmed HU, Freeman A, Kirkham A, et al. The following codes for treatments and procedures applicable to this guideline are included below for informational purposes. As the bone cortex absorbs high ultrasound energy, periosteal denervation may ensue, resulting in pain relief. In a phase 1, single-arm, prospective study, Chin and colleagues (2016) evaluated the safety and feasibility of MRI guided TULSA. Updated September 20, 2021. A total of 23 studies comprised of 1157 individuals were included. The 2021 American Urological Association (AUA) published a guideline on renal mases and localized renal cancer. December 2016. Salvage magnetic resonance imaging-guided transurethral ultrasound ablation for localized radiorecurrent prostate cancer: 12-month functional and oncological results. Available at. Transurethral ultrasound ablation (TULSA), which delivers directional thermal ultrasound via a catheter inserted into the urethra, is specific to prostate cancer. Eligibility included those at least 18 years old with at least a 3-month life expectancy with bone metastases which were painful despite previous radiation therapy (RT) but unsuitable for further RT. Ultrasound imaging, also called ultrasound scanning or sonography, is a method of obtaining images of internal organs by sending high-frequency sound waves into the body. Please enter a valid 5-digit Zip Code. *Coverage includes fertility preservation . 2000; 37(6):695-701. 2008; 38(3):192-199. Guillaumier S, Peters M, Arya M, et al. There are currently two ultrasound ablative techniques. Specific findings associated with congenital Zika syndrome include intracranial calcifications, microcephaly, ventriculomegaly, arthrogryposis; abnormalities of the corpus callosum, cerebrum, cerebellum, and eyes; and other brain abnormalities. Crouzet S, Chapelon JY, Rouvire O, et al. The 2018 American Urological Association/American Society for Radiation Oncology/Society of Urologic Oncology (AUA/ASCO/SUO) notes that high intensity focused ultrasound treatment is not a standard care option for low, intermediate or high risk or localized prostate cancer. Eur Urol. Focal high intensity focused ultrasound of unilateral localized prostate cancer: a prospective multicentric hemiablation study of 111 patients. Pain severity was measured using a 10-point pain scale questionnaire. The PSA decreased from a median of 6.26 to 0.53 at 12 months. MR-guided focused ultrasound (MRgFUS) ablation for the treatment of nonspinal osteoid osteoma: a prospective multicenter evaluation. Eur Urol. Ultrasound during pregnancy is used to assess the uterus, umbilical cord and placenta, as well as fetal anatomy and well-being. Anthem Blue Cross Blue Shield: Health Insurance, Medicare & More Learn more about your coverage options after the Public Health Emergency (PHE) ends. Visit our official site today for more details. MPTAC review. Assessment of fetal well being, in the absence of the signs, symptoms, or conditions listed above; Providing a keepsake picture of the baby for the parents. Shi Y, Ying X, Hu X, et al. BJU Int. Br J Surg. 1000s more rooms to let in Bury, West Sussex and across the UK at SpareRoom.co.uk - the UK's #1 flatshare site. Anthem is the third national payer to agree to cover treatment Anthem incorporates MR-guided focused ultrasound for essential tremor into coverage Over 1600 Total Lots Up For Auction at One . Ultrasound imaging can be used after delivery to evaluate abnormalities of the reproductive and adjacent structures. Breast MRI costs an average $615 under Medicare . Bone metastases are common in breast and prostate cancer (Liberman, 2009). Effectiveness of 12-13-week scan for early diagnosis of fetal congenital anomalies in the cell-free DNA era. Updated Coding section with 10/01/2016 ICD-10-CM diagnosis code changes. Approximately 98% of subjects received 1 (60%) or 2 treatments (38%). In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia . Updated Description, Discussion, References and Websites for Additional Information sections. Prenatal ultrasound-series. J Endourol. grievance or appeal. A complete resolution of pain at 1 year follow-up was shown in 2 participants (Joo, 2015). There was 1 in-field and 2 out-of-field recurrences reported at that time. Palermo G, Totaro A, Sacco E, et al. Magnetic resonance imaging-guided transurethral ultrasound ablation of prostate tissue in patients with localized prostate cancer: a prospective Phase 1 clinical trial. The SBC shows you how you and the ACR-ACOG-AIUM-SMFM-SRU Practice parameter for the performance of obstetrical ultrasound. The American College of Obstetricians and Gynecologists (ACOG) 2018 Practice Bulletin Ultrasound in Pregnancy lists the following recommendations: The following conclusions are based on good and consistent evidence (Level A): The following conclusions are based on limited or inconsistent evidence (Level B): The following conclusion and recommendation are based primarily on consensus and expert opinion (Level C): The American College of Radiology (ACR), the American Institute of Ultrasound in Medicine (AIUM), ACOG, the Society for Maternal Fetal Medicine (SMFM), and the Society of Radiologists in Ultrasound (SRU) practice parameter (2018) notes: A standard obstetrical ultrasound examination in the first trimester includes evaluation of the presence, size, location, and number of gestational sac(s). Focal salvage high-intensity focused ultrasound in radiorecurrent prostate cancer. MPTAC review. J Ther Ultrasound. Napoli A, Anzidei M, Marincola BC, et al. NCD #220.5. Invest Radiol. Pain palliation for localized metastatic bone pain Bone pain is a common complaint for individuals with metastatic cancer to the bone. Whitworth M, Bricker L, Mullan C. Ultrasound for fetal assessment in early pregnancy. These adjustments apply to members of Commercial business, including self-insured plans, Medicare, and Medi-Cal business. 2015; 2015(7):CD007058. In 2013, Napoli and colleagues treated 18 individuals with painful bone metastases with MRgFUS. Coverage varies some from plan to plan, so check your plan's specifics. Unlisted procedure, breast [when specified as destruction of breast tissue by high intensity focused ultrasound], Unlisted procedure, urinary system [when specified as transurethral MRI directional ultrasound ablation of prostate tissue (TULSA)], Ablation of malignant prostate tissue, transrectal, with high intensity-focused ultrasound (HIFU), including ultrasound guidance. 2015; 10(2):e0118212. For instance, if you want to take advantage of inversion therapy, massage, ultrasound therapy, or computer-assisted adjustments, youll need to ask your insurance company about the availability of coverage for these things . Transrectal high-intensity focused ultrasound: minimally invasive therapy of localized prostate cancer. Number 7. Updated Coding section with 10/01/2017 ICD-10-CM diagnosis code changes. Anthem becomes the third national payor to cover the treatment after Aetna and Blue Cross Blue Shield Association gave it positive coverage decisions in April 2021 and August 2018, respectively. The use of HIFU in the setting of breast cancer treatment may not allow for an adequate collection of tumor specimens to evaluate the tumor histopathology. This guideline was reviewed and validated in 2011. 2000; 4(3):183-187. Transrectal high-intensity focused ultrasound in the treatment of localized prostate cancer: a multicenter study. In 2021, Nair and colleagues reported the 3-year outcomes of the participants in the Chin study. Systematic review of innovative ablative therapies for the treatment of locally advanced pancreatic cancer. Adverse events included grade 1 or 2 hematuria, urinary tract infections or acute urinary retention, and grade 3 epididymitis. This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for Ultrasound, Soft Tissues of Head and Neck. Providers are responsible for billing the appropriate CPT code, modifier, and diagnosis combinations. MPTAC review. Pregnant Women. There were no treatment-related AEs. Participants received either MRgFUS (n=112) or placebo (n=35) treatment. Bonekamp and associates (2019) performed a quantitative analysis of viable prostate tissue volume reduction at 12 months post-procedure. BJU Int. 2019; 29(1):299-308. Participants included those who could not undergo or refused all other available options for pain palliation. AIUM Practice Parameter for the Performance of Detailed Diagnostic Obstetric Ultrasound Examinations Between 12Weeks 0Days and 13Weeks 6Days. Poissonnier L, Chapelon JY, Rouviere O, et al. Bone Metastases. The maternal cervix and adnexa should be examined. At 3 months, 72.2% (13/18) reported no pain without the use of pain medication, and 16.7% (3/18) reported a drop of at least 2 points on pain scale without an increase in pain medication. Postpartum hemorrhage. close combat footage enemy visible bungee fitness dickson tn Tue, Oct 18 2022 Clin Oncol (R Coll Radiol). American College of Radiology (ACR). The five HIFU trials included a total of only 136 individuals. This prospective case series did not compare HIFU long-term survival and morbidity rates with the rates of other standard treatments. Alternatively, the reduced tumor mass caused by thermal ablation may have an analgesic effect. Pak J Pharm Sci. In the 25 participants that were able to tolerate a complete treatment, 72% (18/25) reported significant pain reduction of at least 2 points on the VAS scale, 24% (6/25) reported no reduction in pain and 4% (1/25) reported an increase in pain levels. In brief: classifications in brief: Mirels' classification: metastatic disease in long bones and impending pathologic fracture. Technology insight: High-intensity focused ultrasound for urologic cancers. For other common visits, this is what you'll pay with PPO. MPTAC review. When services are Medically Necessary for routine anatomy screen and dating when criteria are met: Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks, 0 days), transabdominal approach; single or first gestation/each additional gestation [includes codes 76801, 76802], Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> 14 weeks 0 days), transabdominal approach; single or first gestation/each additional gestation [includes codes 76805, 76810], Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation/each additional gestation [includes codes 76811, 76812], Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses, Ultrasound, pregnant uterus, real time with image documentation, follow-up (eg, re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ system(s) suspected or confirmed to be abnormal on a previous scan), transabdominal approach, per fetus, Ultrasound, pregnant uterus, real time with image documentation, transvaginal. Initial document development. Although use of HIFU or MRgFUS for primary prostate cancer or for prostate cancer metastatic to locations other than bone has not entered the generally accepted standard care for these conditions, treatment of pain related to prostate cancer metastatic to bone may provide benefits to affected men. The identified primary endpoint was the improvement in self-reported pain score without an increase in pain medication utilization at 3 months. Mol Urol. 2017; 197(1):97-102. World J Gastroenterol. Bone pain is a common complaint for individuals with metastatic cancer to the bone. Clinical guidelines approved by the Medical Policy & Technology Assessment Committee are available for general adoption by plans or lines of business for consistent review of the medical necessity of services related to the clinical guideline when the plan performs utilization review for the subject. In February 2000, the labeled indication for the SAFHS (now known as the Exogen device) (Smith and Nephew, Inc., Biologics & Spine, Durham, NC) was expanded to include the treatment of established fracture nonunions, excluding the skull and vertebra. Eur Urol. However, there are no data specific to congenital Zika virus infection to guide recommendations for timing of serial ultrasounds; ob-gyns and other obstetric providers may consider extending the time interval between ultrasounds in accordance with patient preferences and clinical judgement. ; AUA Prostate Cancer Clinical Guideline Update Panel. 2001; 15(4):437-440. In 2016, ACOG and the SMFM released a practice advisory regarding the current information and recommendations regarding the Zika virus. Pregnant Women. MPTAC review. Whole-gland salvage high-intensity focused ultrasound therapy for localized prostate cancer recurrence after external beam radiation therapy. Statement on Biological Effects of Ultrasound in Vivo. Available at: U.S. National Library of Medicine. 15727 Anthem Pkwy, Suite 600 . Therapies for clinically localized prostate cancer [Internet]. Prostate Cancer. The most commonly reported complications included Stress 1 urinary incontinence (18.7%), followed by obstruction of the bladder outlet (16.6%), and acute urinary retention (7.6%). Clin Genitourin Cancer. In addition to the active and pending Medical Policies, BCBSIL has included policies which are under development or being revised. Focal therapy for localised unifocal and multifocal prostate cancer: a prospective development study. 2015; 102(8):873-882. To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the member's card. High-intensity focused ultrasound and localized prostate cancer: efficacy results from the European multicentric study. The SBC shows you how you and the plan would share the cost for covered health care services. J Urol. Available at: Centers for Medicare and Medicaid Services. Pathological, oncologic and functional outcomes of a prospective registry of salvage high intensity focused ultrasound ablation for radiorecurrent prostate cancer. 2021; 205(3):769-779. Boccon-Gibod L, Djavan WB, Hammerer P, et al. Anthem isn't the only insurer trying to find a way around hospitals' steeper costs for outpatient imaging, says Lea Halim, a senior consultant at the Advisory Board, a health care research and. Can J Urol. In the absence of specific indications, the optimal time for a single ultrasound examination is at 1822 weeks of gestation. 2015; 28(3 Suppl):1097-1100. Thuroff S, Chaussy C, Vallancien G, et al. 2015; 2015(6):CD001451. The recommendations are based on limited data. Control of prostate cancer by transrectal HIFU in 227 patients. Twelve-month prostate volume reduction after MRI-guided transurethral ultrasound ablation of the prostate. Chaussy C, Thuroff S. Results and side effects of high-intensity focused ultrasound in localized prostate cancer. Uddin Ahmed H, Cathcart P, Chalasani V, et al. The document header wording updated from Current Effective Date to Publish Date. Updated Discussion/General Information, References and Websites for Additional Information sections. Chen L, Wang K, Chen Z, et al. * Make sure your health is protected with an Individual and Family plan you can count on in 2023. Removed ICD-9 codes from Coding section. Surgery: MRgFUS-non invasive treatment for patients with painful bone metastasis. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. $0 plans in select areas. The prospective, nonrandomized, investigator-initiated, single-arm, single-center phase 1 study included 11 individuals with localized, histopathologically verified, radio-recurrent prostate cancer. That coverage comes at a cost, however; specifically, Plan F is the most expensive of all the MedSup policies on the market today. Revised May 20, 2020. NOTE: Information about the cost of this plan (called the . 2016; 19(3):311-316. For any of the diagnosis codes listed below for abnormalities and high-risk conditions, and including the following: Encounter for supervision of normal pregnancy [codes 76801, 76805, when criteria are met], Encounter for antenatal screening of mother, When services may be Medically Necessary when criteria are met for known or suspected abnormality of maternal reproductive structure, fetus, or placenta, or fetal viability or other high-risk conditions:For the procedure codes listed above for the following diagnoses, Incomplete spontaneous abortion without complication, Complete or unspecified spontaneous abortion without complication, Failed attempted termination of pregnancy without complication, Supervision of pregnancy with history of infertility, Supervision of pregnancy with history of ectopic pregnancy, Supervision of pregnancy with history of molar pregnancy, Supervision of pregnancy with history of pre-term labor, Supervision of pregnancy with other poor reproductive or obstetric history, Supervision of pregnancy with insufficient antenatal care, Supervision of elderly primigravida and multigravida, Supervision of other or unspecified high risk pregnancy, Pre-existing essential hypertension complicating pregnancy, Pre-existing hypertensive heart disease complicating pregnancy, Pre-existing hypertensive chronic kidney disease complicating pregnancy, Pre-existing hypertensive heart and chronic kidney disease complicating pregnancy, Pre-existing secondary hypertension complicating pregnancy, Unspecified pre-existing hypertension complicating pregnancy, Pre-existing hypertension with pre-eclampsia; first, second or third trimester, Pre-existing hypertension with pre-eclampsia; unspecified trimester, Mild to moderate pre-eclampsia; unspecified, second or third trimester, Severe pre-eclampsia; unspecified, second or third trimester, HELLP syndrome; unspecified, second or third trimester, Unspecified pre-eclampsia; unspecified, second or third trimester, Unspecified maternal hypertension; first, second or third trimester, Unspecified maternal hypertension; unspecified trimester, Pre-existing diabetes mellitus, type 1, in pregnancy, Pre-existing diabetes mellitus, type 2, in pregnancy, Unspecified pre-existing diabetes mellitus in pregnancy, Gestational diabetes mellitus in pregnancy, Other pre-existing diabetes mellitus in pregnancy, Unspecified diabetes mellitus in pregnancy, Pregnancy care for patient with recurrent pregnancy loss, Retained intrauterine contraceptive device in pregnancy, Uterine size-date discrepancy complicating pregnancy, Complications specific to multiple gestation, Maternal care for malpresentation of fetus, Maternal care for abnormality of pelvic organs, Maternal care for known or suspected fetal abnormality and damage, Maternal care for known or suspected poor fetal growth, Maternal care for viable fetus in abdominal pregnancy, Pregnancy with inconclusive fetal viability, Maternal care for abnormalities of the fetal heart rate or rhythm, Maternal care for other specified fetal problems, Maternal care for fetal problem, unspecified, Other disorders of amniotic fluid and membranes, Fetus-to-fetus placental transfusion syndrome, Morbidly adherent placenta, other/unspecified placental disorder, Premature separation of placenta (abruptio placentae), Retained placenta and membranes, without hemorrhage, Abnormality in fetal heart rate and rhythm complicating labor and delivery, Other specified diseases and conditions complicating pregnancy, Contact with and (suspected) exposure to Zika virus. 2000; 14(6):519-528. 2014; 2014:186782. 2004; 63(2):297-300. Plans include prescription drug and behavioral health coverage as well as telemedicine services and free AirMed medical transportation. At various gestational ages, ultrasound examination is an accurate method of determining gestational age, fetal number, viability, and placental location, and it is recommended for all pregnant patients. Focal therapy for localized prostate cancer: a phase I/II trial. The price of a diagnostic mammogram averages from $172 under Medicare to $239 with private insurance. Peek MC, Ahmed M, Napoli A, et al. Clin Orthop Relat Res. The clearance was based upon the Ablatherm device as the predicate device. Revised September 16, 2022. Ultrasound, the use of low-intensity sound waves to produce images, is an established diagnostic tool. NOTE: Information about the cost of this plan (called the premium) will be . 2004; 63(4):625-629. 2014; 7(4):270-281. Urol Oncol. MedlinePlus. Eur Urol Open Sci. This recommendation is based upon prospective and retrospective studies (Ahmed, 2012; Baco, 2014; Crouzet, 2012; Crouzet, 2017; Kanthabalan, 2017; Palermo, 2017; Rischmann, 2017; Shah, 2016; Siddiqui, 2016; Uddin 2012). In a systematic review, Li and colleagues (2014) performed a meta-analysis on the use of HIFU in combination with radiotherapy or chemotherapy in the treatment of pancreatic cancer. Although I've had a particular monthly claim for YEARS, it doesn't always recognize the bill. 2016; 70(3):447-455. Available at: Dahm P, Brasure M, Ester E, et al. In some states, insurance must cover . No ionizing radiation (x-ray) is used in ultrasound imaging. Available at: Centers for Disease Control and Prevention (CDC): How is Prostate Cancer Treated? Specific findings associated with congenital Zika syndrome include intracranial calcifications, microcephaly, ventriculomegaly, arthrogryposis; abnormalities of the corpus callosum, cerebrum, cerebellum, and eyes; and other brain abnormalities. BJU Int. These resources can help members understand their maternity benefits. Obstetric Care Consensus. Improved outcomes with advancements in high intensity focused ultrasound devices for the treatment of localized prostate cancer. Accessed on September 13, 2022. ACOG Practice Bulletin Number 183, October 2017. Kenkhuis MJA, Bakker M, Bardi F, ET AL. The single-arm, prospective, multi-center pivotal trial, TULSA-PRO Ablation Clinical Trial (TACT), enrolled 115 individuals with intermediate risk (67.0%) or low risk (33.0%) organ confined prostate cancer who underwent whole gland prostate ablation (Klotz, 2021). Beerlage HP, Thuroff S, Debruyne FM, et al. J Evid Based Med. The location you tried did not return a result. J Endourol. To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the member's card. Updated grammar in medically necessary statement regarding maternal risk factors from including but not limited to, hypertension, diabetes, sickle cell disease preeclampsia), substance abuse, or hyperemesis gravidarum to including but not limited to, hypertension, diabetes or sickle cell disease), preeclampsia, substance abuse or hyperemesis gravidarum. Retroperitoneal ultrasound (US) studies represent the ultrasonic imaging of retroperitoneal organs for the diagnosis and management of abnormalities that occur within the retroperitoneum. Ahmed HU, Cathcart P, McCartan N, et al. Available at: ACOG. 2005; 12(2):2593-2597. Routine ultrasound in late pregnancy (after 24 weeks' gestation). Reformatted Coding section. $15 UK HEALTHCARE PRIMARY CARE CO-PAY $25 ANTHEM PRIMARY CARE CO-PAY $40 MPTAC review. Early prospective studies evaluating MRgFUS reported promising results. While the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines (CPG) in Oncology for Adult Cancer Pain (V2.2022) document notes that the palliative effects of HIFU have been demonstrated in several small studies, no recommendation for or against the use of HIFU for pain palliation was given. Clarification to Not Medically Necessary Statement. Adult Cancer Pain (V2.2022). September 15, 2017. U.S. Food and Drug Administration (FDA). Palliative Care. Ultrasound in pregnancy. Urology. Uchida T, Sanghvi NT, Gardner TA, et al. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member. Treatment of localized prostate cancer using high-intensity focused ultrasound. Crouzet S, Blana A, Murat FJ, et al. The new Multiple Delivery policy has the same . A clinically significant biopsy was reported in 34% (10/29) of participants with 59% (17/29) of participants reporting any positive biopsy. 2011; 185(4):1246-1254. The TULSA-PRO (Profound Medical Corp., Fort Myers, FL) received 510(k) clearance by the FDA in 2019. The study has several methodological flaws, including lack of a comparison group, and uncertainty regarding the percentage of subjects who completed the follow-up period. Peek and associates (2015) conducted a systematic review of the use of HIFU in breast cancer. Recommendations for the management of a pregnant individuals with suspected Zika virus infection include: The 2021 CDC guideline on the treatment of sexually transmitted infections includes management recommendations for individuals who are diagnosed with text in the second half of pregnancy. Albisinni S, Aoun F, Bellucci S, et al. BJU Int. A statistically significant pain response was reported in 70.7% of this group. Mirels scoring system: A scoring system based upon lesion characteristics and pain levels used to classify pathologic fracture risk. June 7, 2018. The feasibility and safety of high-intensity focused ultrasound as salvage therapy for recurrent prostate cancer following external beam radiotherapy. Updated Description, Discussion and References sections. Find a doctor near you. Hematology/Oncology Subcommittee review. Known or suspected abnormality of maternal reproductive structure: Clinical suspicion of cervical insufficiency (for example, abnormal cervix on physical examination, maternal history of second trimester pregnancy loss, prior cervical surgery, and diethylstilbestrol [DES] exposure); To assess cervical length in the second or third trimester in individuals with a history of one or more pregnancy losses in the second or early third trimester or in individuals who have had preterm labor in the current pregnancy or in multi-fetal pregnancies; Provide guidance for cervical cerclage placement; Confirm suspected anatomical uterine abnormality, including fibroid uterus; Localization of intrauterine device (IUD); Evaluate a pelvic mass that has been detected clinically. Two-year results of transurethral resection of the prostate versus four 'less invasive' treatment options. Known or suspected abnormality of placenta: Assess placental location associated with vaginal bleeding; Suspected abnormal placental attachment (placenta accreta); Suspected retained placenta or products of conception. Uchida T, Tomonaga T, Kim H, et al. There are concerns about inconsistent treatment coverage within renal masses resulting in incomplete ablation. The sound wave echoes are recorded and displayed as a real-time visual image. Blana A, Murat FJ, Walter B, et al. ACOG Practice Bulletin Number 171. Anttinen M, Mkel P, Viitala A, et al. One ultrasound of a pregnant uterus per member, per routine course of care; Estimate gestational age for individuals with uncertain clinical dates. Available at: American Cancer Society. CPT Only - American Medical Association, RAD.00038 Use of 3-D, 4-D or 5-D Ultrasound in Maternity Care, https://www.acog.org/-/media/project/acog/acogorg/clinical/files/committee-opinion/articles/2017/10/guidelines-for-diagnostic-imaging-during-pregnancy-and-lactation.pdf, https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2018/12/placenta-accreta-spectrum, https://www.acog.org/clinical/clinical-guidance/practice-bulletin, https://www.smfm.org/publications/220-acog-smfm-joint-practice-advisory-interim-guidance-for-care-of-obstetric-patients-during-a-zika-virus-outbreak, https://www.acr.org/-/media/ACR/Files/Practice-Parameters/US-OB.pdf, https://acsearch.acr.org/docs/69465/Narrative/?_ga=2.211725906.656052169.1601908671-191399006.1564351312, https://acsearch.acr.org/docs/3102400/Narrative/, https://www.aium.org/resources/guidelines/obstetric.pdf, https://www.aium.org/resources/statements.aspx, https://www.aium.org/resources/guidelines.aspx, https://www.cdc.gov/std/treatment-guidelines/STI-Guidelines-2021.pdf, https://www.cdc.gov/zika/hc-providers/types-of-tests.html, https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/ncd103c1_part4.pdf, https://www.acog.org/Patients/FAQs/Routine-Tests-During-Pregnancy, https://www.cdc.gov/ncbddd/birthdefects/diagnosis.html, https://www.cdc.gov/zika/prevention/index.html, https://medlineplus.gov/ency/presentations/100197_1.htm. Ultrasound Obstet Gynecol. J Endourol. For pregnant women with laboratory evidence of Zika infection, ultrasound to evaluate for fetal abnormalities consistent with congenital Zika virus syndrome is recommended. See the following related document for HIFU treatment non-oncologic indications: For information regarding other palliative treatments of metastatic bone lesions, please see the following: Metastatic lesions located 1 centimeter (cm) or greater from skin and major nerve bundles; Individual does not present an increased risk of fracture from the procedure (for example, a score of 7 or less on Mirels fracture risk score); Individual does not require surgical stabilization or have clinically significant comorbidities; Individual is not a candidate for other therapies as evidenced by pain refractory to previous radiation therapy. Sbc shows you how you and the plan would share the cost this. Totaro a, Chapelon JY, Rouviere O, et al incomplete ablation H, et al pharmacological. 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