ACOG Practice Bulletin 175. HIFU has been proposed as a treatment for multiple oncologic conditions. Non-Contact Ultrasound Treatment for Wounds; Non-Oncologic Uses of Rituximab (Rituxan) Nutritional Treatment of Childhood Medical Conditions; Ophthalmologic Techniques for Evaluating Glaucoma; Optical Diagnostic Devices for Evaluating Skin Lesions Suspected of Malignancy ; Oral Lesion Identification System (ViziLite, Velscope) Urology. Curr Urol Rep. 2003; 4(3):248-252. Clin Orthop Relat Res. The SBC shows you how you and the plan would share the cost for covered health care services. 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. 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. July 25, 2018. These resources can help members understand their maternity benefits. Update date: March 4, 2022. J Ultrasound Med 2013; 32(6):1083-1101. Practice Advisory Interim Guidance for Care of Obstetric Patients During a Zika Virus Outbreak. Before you decide to pass on Plan F, though, do your due diligence and see how much the insurance . ACOG Practice Bulletin Number 171. Alternatively, the reduced tumor mass caused by thermal ablation may have an analgesic effect. CPT Only - American Medical Association, MED.00057 MRI Guided High Intensity Focused Ultrasound Ablation for Non-Oncologic Indications, CG-SURG-61 Cryosurgical, Radiofrequency or Laser Ablation to Treat Solid Tumors Outside the Liver, https://acsearch.acr.org/docs/69397/Narrative, https://www.auanet.org/guidelines-and-quality/guidelines/renal-mass-and-localized-renal-cancer-evaluation-management-and-follow-up, https://www.astro.org/uploadedFiles/_MAIN_SITE/Patient_Care/Clinical_Practice_Statements/Content_Pieces/ClinicallyLocalizedProstateCancer.pdf, https://www.accessdata.fda.gov/cdrh_docs/pdf15/k153023.pdf, https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K172721, https://www.accessdata.fda.gov/cdrh_docs/pdf19/K191200.pdf, https://www.accessdata.fda.gov/cdrh_docs/pdf11/p110039b.pdf, http://www.cancer.org/treatment/understandingyourdiagnosis/bonemetastasis/bone-metastasis-treating-problems-caused, http://www.cdc.gov/cancer/prostate/basic_info/treatment.htm, https://medlineplus.gov/prostatecancer.html, https://www.nlm.nih.gov/medlineplus/palliativecare.html. Colombel M, Gelet A. 2014; 65(5):907-914. Last Reviewed: August 25, 2022. 2008; 102(7):786-792. Participants included those who could not undergo or refused all other available options for pain palliation. Government Agency, Medical Society, and Other Authoritative Publications: Maternal UltrasoundObstetricPrenatalSonography. MPTAC review. Updated Coding section; added ICD-10-CM code ranges O98.111-O98.119, O99.310-O99.313, O99.320-O99.323, O99.330-O99.333. Updated Coding section with additional diagnosis codes D25.0-D25.9, O26.872-O26.879, O99.210-O99.213, O99.810. 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. Poissonnier L, Chapelon JY, Rouviere O, et al. The current evidence is insufficient to support the use of HIFU as a generally accepted oncological treatment. 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. 2014; 20(28):9570-9577. Hepatogastroenterology. November 17, 2019. Salvage radical prostatectomy following primary high intensity focused ultrasound for treatment of prostate cancer. The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. In 2021, Nair and colleagues reported the 3-year outcomes of the participants in the Chin study. Available at: Papageorghiou AT, Thilaganathan B, Bilardo CM, et al. The 2021 American Urological Association (AUA) published a guideline on renal mases and localized renal cancer. Approved May 19, 2020. The doctors in the emergency room did multiple tests including a CT scan and ultrasound. The majority of events were minor and reversible. 2017; 3:CD012600. . Br J Surg. CPT codes Dx codes 76801 76802 D25, D25.0, D25.1, D25.2, D25.9, O0900, O0901, O0902, O0903, O09511, O09512, 2006b; 97(1):56-61. Indiana Medicaid. Similar to prostate cancer, there is a lack of randomized trials comparing HIFU to standard treatment options. Comprehensive medical coverage that covers many common services at no cost or for a low copay. 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 . American College of Obstetricians and Gynecologists (ACOG). Uchida T, Ohkusa H, Nagata Y, et al. 1999a; 54(2):273-277. Medical Policy & Technology Assessment Committee (MPTAC) review. In those individuals who reported a decrease in pain levels, 50% (9/18) reported complete relief of pain, with 52% reporting significant pain relief beginning 3 days post treatment. ACOG Practice Bulletin Number 183, October 2017. Anthem Blue Cross and Blue Shield - BlueAdvantage POS Colorado Higher Education Insurance Benefits Alliance Trust Coverage for: Individual + Family | Plan Type: HMO . The wait is over. 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. Eur Urology. High-intensity focused ultrasound (HIFU) followed after one to two weeks by radical retropubic prostatectomy: results of a prospective study. Evaluate for threatened, incomplete, or missed abortion; Non-reassuring fetal heart rate monitoring; Assess amniotic fluid volume in post-term gestation. Centers for Disease Control and Prevention (CDC). Thompson I, Thrasher JB, Aus G, et al. The updated file enables providers to separately bill for the professional component (26) and the technical component (TC). BJU Int. 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. HIFU therapy was included in a comparative effectiveness review of clinically localized prostate cancer treatments (Dahm, 2020). Limani K, Aoun F, Holz S, et al. Rombouts SJ, Vogel JA, van Santvoort HC, et al. Prostate cancer is the second leading cause of death with approximately 39,430 deaths in 2018 (Bekelman, 2018). 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. They determined that Cloyd had ovarian cysts, not appendicitis. Geiger D, Napoli A, Conchiglia A, et al. Clin Oncol (R Coll Radiol). 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. AIUM Practice Parameter for the Performance of Limited Obstetric Ultrasound Examinations by Advanced Clinical Providers. 2015; 28(3 Suppl):1097-1100. 2017. The SBC shows you how you and the plan would share the cost for covered health care services. Federal and State law, as well as contract language, and Medical Policy take precedence over Clinical UM Guidelines. The primary endpoint was achieved in 96% (110/115) of participants. On October 9, the FDA granted de novo clearance to SonaCare Medical, LLC (Charlotte, NC) to market the Sonablate 450 for prostate tissue ablation. Updated Coding section to add ICD-10-CM diagnosis codes O09.00-O09.03, O09.811-O09.829. J Endourol. A complete resolution of pain at 1 year follow-up was shown in 2 participants (Joo, 2015). The American Urological Association (AUA) 2007 guideline on prostate cancer notes that conclusions on the outcomes of HIFU cannot be determined as there is minimal data available on this treatment. Focused ultrasound for the treatment of bone metastases: effectiveness and feasibility. The baseline median PSA of 7.6 ng/ml decreased to 0.23 ng/ml at 12 months follow-up. When a growth disturbance is suspected clinically or there is a medical or obstetric condition that increases the risk of a growth disturbance, ultrasonography is the modality of choice to identify abnormal fetal growth. Shah TT, Peters M, Kanthabalan A, et al. American Urological Association (AUA). MPTAC review. Revised September 16, 2022. 2021. Required ultrasound or colonoscopy for select adult patients based on clinical scenario; Ultrasound-first approach for pediatric abdominal and pelvic pain . 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. Int J Clin Pract. J Urol. 2018. Ultrasound is currently being used as a therapeutic treatment, for example, lithotripsy to disintegrate kidney stones. 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. Ultrasound, the use of low-intensity sound waves to produce images, is an established diagnostic tool. 2011; 108(8 Pt 2):E196-E201. Pain palliation in patients with bone metastases using MR-guided focused ultrasound surgery: a multicenter study. 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. American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal Fetal Medicine (SMFM). Committee Opinion 723. Updated Discussion, References and Websites for Additional Information sections. Reaffirmed 2021. Can J Urol. In November, the FDA approved the use of Ablatherm (Maple Leaf; Toronto, Canada) to treat prostate cancer in individuals who previously failed radiation therapy. Ganzer R, Robertson CN, Ward JF, et al. December 2016. 2016; 19(3):311-316. Eur Urol. Available at: U.S. National Library of Medicine. In a phase 1, single-arm, prospective study, Chin and colleagues (2016) evaluated the safety and feasibility of MRI guided TULSA. MPTAC review. J Ultrasound Med. 2014; 106(5). Plans include prescription drug and behavioral health coverage as well as telemedicine services and free AirMed medical transportation. Bone pain is a common complaint for individuals with metastatic cancer to the bone. Due to variances in utilization patterns, each plan may choose whether to adopt a particular Clinical UM Guideline. BJU Int. Review January 10, 2022. Uchida T, Sanghvi NT, Gardner TA, et al. 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. Breast MRI costs an average $615 under Medicare . BJU Int. Int J Urol. Bertrand AS, Iannessi A, Natale R, et al. 2000; 37(6):695-701. 2015; 10(2):e0118212. Individuals received either whole gland (n=8) or partial (n=8) ablation. Reaffirmed October 2021. Elterman D, Li W, Hatiboglu G, et al. Revised 2020. 2010; 17(8):715-719. 2004; 63(4):625-629. Available at: High Intensity Ultrasound System for Prostate Tissue Ablation (TULSA-PRO System). Moved content of MED.00119 High Intensity Focused Ultrasound (HIFU) for Oncologic Indications to new clinical utilization management guideline document with the same title. Chaussy C, Thuroff S. Results and side effects of high-intensity focused ultrasound in localized prostate cancer. $0 virtual care, 24/7. Hemi salvage high-intensity focused ultrasound (HIFU) in unilateral radiorecurrent prostate cancer: a prospective two-centre study. There were no new reported serious AEs. NOTE: Information about the cost of this plan (called the . ultrasound). American College of Radiology (ACR). Nat Clin Pract Urol. Cancer. Clarification to Not Medically Necessary Statement. Screening for Fetal Aneuploidy. In a prospective, non-randomized single arm trial, MRgFUS was used on 5 individuals with painful bone metastatic lesions with a pain rating of 4 or higher. Salvage magnetic resonance imaging-guided transurethral ultrasound ablation for localized radiorecurrent prostate cancer: 12-month functional and oncological results. Available at: Limited obstetrical ultrasound examination. Effects of high-intensity focused ultrasound for treatment of abdominal lymph node metastasis from gastric cancer. Routine ultrasound in late pregnancy (after 24 weeks' gestation). Mol Urol. The overall survival (OS) rate was 80%, the progression-free survival (PFS) rate was 94%, and the disease-specific survival rate was 97%. The uterus, cervix, adnexa, and cul-de-sac region should be examined. Peek and associates (2015) conducted a systematic review of the use of HIFU in breast cancer. 2009; 16(1):140-146. Day 1 health insurance coverage and comprehensive benefits options 401(k) matching program In the absence of specific indications, the optimal time for a single ultrasound examination is at 1822 weeks of gestation. BJU Int. First analysis of the long-term results with transrectal HIFU in patients with localised prostate cancer. 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,. NOTE: Information about the cost of this plan (called the premium) will be . Focal salvage therapy for localized prostate cancer recurrence after external beam radiotherapy: a pilot study. Ultrasound Tech in San Antonio, Texas, United States. A total of 23 studies comprised of 1157 individuals were included. Prostate Cancer Prostatic Dis. One of the largest of these studies was conducted by Ganzer and colleagues (2011). You should contact Anthem Blue Cross and Blue Shield directly to appeal denial of coverage for medical claims by calling 1855- -641-4862. Ann Surg Oncol. Treatment of other oncologic indicationsWhen services are Not Medically Necessary:For the following procedure codes; or when the code describes a procedure designated in the Clinical Indications section as not medically necessary. 2015; 56(2):503-509. Nair SM, Hatiboglu G, Relle J, et al. For more information about your rights, look at the explanation of benefits you will receive for that medical claim. : 20-EHC022. 2008; 38(3):192-199. Although the exact mechanism of analgesic action of MRgFUS in pain palliation is unknown, studies have pointed to a few explanations. Cochrane Database Syst Rev. AIUM Practice Parameter for the Performance of Detailed Second- and Third-Trimester Diagnostic Obstetric Ultrasound Examinations. ; AUA Prostate Cancer Clinical Guideline Update Panel. Two-year results of transurethral resection of the prostate versus four 'less invasive' treatment options. In some states, insurance must cover . To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the member's card. 2017; 71(2):267-273. 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. Updated Coding section with 10/01/2016 ICD-10-CM diagnosis code changes. Eur Urol. Ultrasound Obstet Gynecol. Indiana Medicaid for Members. Available at: AUA / American Society for Radiation Oncology (ASTRO) / Society of Urologic Oncology (SUO). 2018; 6:8. Eur Urol. Available at: U.S. National Library of Medicine. Prostate Cancer Prostatic Dis. Liberman and associates (2009) used MRgFUS to treat 31 individuals with painful bone metastases who had exhausted or refused all other pain palliation methods. Post-treatment biopsies were available in 77% of subjects. September 15, 2017. The location you tried did not return a result. 2005; 19(6):693-701. Sonablate was classified as a class II device. Prostate Cancer (V1.2023). The document header wording updated from Current Effective Date to Publish Date. Updated Discussion/General Information, References and Websites for Additional Information sections. Obstetric Care Consensus. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. Federal and State law, as well as contract language, and Medical Policy take precedence over Clinical UM Guidelines. Available at: Centers for Medicare and Medicaid Services. No ionizing radiation (x-ray) is used in ultrasound imaging. Beerlage HP, Thuroff S, Debruyne FM, et al. 2017; 197(1):97-102. 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. Chaussy C, Thuroff S, Rebillard X, Gelet A. . Muto S, Yoshii T, Saito K, et al. This prospective case series did not compare HIFU long-term survival and morbidity rates with the rates of other standard treatments. Anttinen and associates (2020) evaluated TULSA use as a partial salvage therapy in individuals with localized, recurrent prostate cancer. An mpMRI, a transrectal ultrasound guided biopsy and a cystoscopy were performed at 12 months post-procedure. Find job postings in CA, NY, NYC, NJ, TX, FL, MI, OH, IL, PA, GA, MA, WA, UT, CO, AZ, SF Bay Area, LA County, USA, North America / abroad. Blana A, Walter B, Rogenhofer S, Wieland WF. Salvage high-intensity focused ultrasound for patients with recurrent prostate cancer after brachytherapy. 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. Pregnant Women. Birth Defects Homepage: Diagnosis. Please enter a valid 5-digit Zip Code. J Pharm Bioallied Sci. Ultrasound examinations can be used to assess fetal anatomy, particularly neuroanatomy, and to monitor growth. It is completely automated and therefore extremely rigid. In addition to treatment, these individuals should undergo a sonographic fetal evaluation to evaluate for signs of fetal or placental syphilis. Transurethral ultrasound ablation (TULSA), which delivers directional thermal ultrasound via a catheter inserted into the urethra, is specific to prostate cancer. In brief: classifications in brief: Mirels' classification: metastatic disease in long bones and impending pathologic fracture. American College of Obstetricians and Gynecologists (ACOG). 2012; 118(12):3071-3078. 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. NCD #220.5. BJU Int. Comparing high-intensity focal ultrasound hemiablation to robotic radical prostatectomy in the management of unilateral prostate cancer: a matched-pair analysis. Approved August 19, 2021. 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. MedlinePlus. High-intensity focused ultrasound and localized prostate cancer: efficacy results from the European multicentric study. Five years experience of transrectal high-intensity focused ultrasound using the Sonablate device in the treatment of localized prostate cancer. . In the case of monochorionic twins, one scan per two weeks in the third trimester is considered medically necessary; For twin-twin transfusion syndrome, one scan per week and serial exams, more than once per week, beginning once the diagnosis of monochorionic twins or twin-twin transfusion is made; Confirm suspected abnormal fetal position or presentation; As an adjunct to external version from breech to vertex presentation; A known or suspected exposure to Zika virus. 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. 2021; 35(4):497-505. Bone metastases are common in breast and prostate cancer (Liberman, 2009). Reaffirmed 2018. Medical Policy & Technology Assessment Committee (MPTAC) review. In the first phase III study published, Hurwitz and colleagues (2014) conducted a randomized, placebo-controlled, single-blind, multicenter, pivotal trial which included 147 participants with bone metastases from breast, prostate, kidney, lung or other primary tumors. 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. Medicare Supplement Plan F is great because it provides the most coverage of the 10 currently available MedSup plans. Bone Metastases. One ultrasound of a pregnant uterus per member, per routine course of care; Estimate gestational age for individuals with uncertain clinical dates. Accessed on October 20, 2022. The anthem blue cross rehab coverage is depending on the location of the policyholder and the specifics of their plan. The treatment group reported an AE frequency of 76.2% versus 23.8% in the sham group. Available at: Centers for Disease Control and Prevention (CDC). These studies have a number of methodological limitations, including a lack of randomization of participants, a lack of a comparator group and limited follow-up for oncologic outcomes. Influence of high intensity focused ultrasound (HIFU) treatment to the pancreatic function in pancreatic cancer patients. The use of high intensity focused ultrasound (HIFU) is considered medically necessary for pain palliation in individuals with localized metastatic bone pain when all the following criteria are met: High intensity focused ultrasound (HIFU) is considered not medically necessary when the above criteria are not met and for all other indications, including but not limited to, the treatment of prostate cancer. Management of prostate-specific antigen relapse in prostate cancer: a European Consensus. 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. There are concerns about inconsistent treatment coverage within renal masses resulting in incomplete ablation. Updated Coding section; corrected ICD-10 diagnosis code O41.00X0. Added Websites for Additional Information section. BJU Int. That coverage comes at a cost, however; specifically, Plan F is the most expensive of all the MedSup policies on the market today. Magnetic resonance imaging-guided transurethral ultrasound ablation of prostate cancer. Cochrane Database Syst Rev. 2012; 116(3):201-205. Available at: Second and Third Trimester Vaginal Bleeding. J Endourol. 2008; 53(6):1194-1201. BJU Int. 2021; 205(3):769-779. This will stop any POWER account payment or copays while you are pregnant, and for 12 months after giving birth. The mean reduction in the NRS score was significant between MRgFUS and placebo (3.6 3.1 versus 0.7 2.4). 2012; 118(17):4148-4155. Updated Coding section with 10/01/2020 ICD-10-CM changes; added O99.891; removed Q51.20 deleted 09/30/2020. TULSA was developed as an alternative method of prostate tissue ablation. For other common visits, this is what you'll pay with PPO. 2011; 185(3):862-868. HIP Maternity will cover enhanced benefits . Ahmed HU, Freeman A, Kirkham A, et al. Focal salvage high-intensity focused ultrasound in radiorecurrent prostate cancer. 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). Local recurrence of prostate cancer after external beam radiotherapy: early experience of salvage therapy using high-intensity focused ultrasonography. J Urol. Hematology/Oncology Subcommittee review. Updated Description, Discussion and References sections. Updated Coding section to include ICD-10-CM diagnosis codes Z36.0-Z36.9. 2018; 30(4):233-242. 2016; 70(3):447-455. Results indicated that median survival in RFA, IRE and SBRT was more favorable compared to HIFU. 1000s more rooms to let in Bury, West Sussex and across the UK at SpareRoom.co.uk - the UK's #1 flatshare site. J Urol. This early study focused on safety and technical feasibility rather than clinical outcomes. For pregnant women with laboratory evidence of Zika infection, ultrasound to evaluate for fetal abnormalities consistent with congenital Zika virus syndrome is recommended. Replaced term women with individual within clinical indications. Lumiani A, Samun D, Sroka R, Muschter R. Single center retrospective analysis of fifty-two prostate cancer patients with customized MR-guided transurethral ultrasound ablation (TULSA). Low-Intensity Pulsed Ultrasound for Fracture Nonunion. Schatzl G, Madersbacher S, Djavan B, et al. Crouzet S, Blana A, Murat FJ, et al. 2004; 63(2):297-300. 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. American College of Radiology (ACR). Cochrane Database Syst Rev. 2014; 2014:186782. Prostate Cancer. Updated Coding section with 10/01/2017 ICD-10-CM diagnosis code changes. World J Gastroenterol. 2000; 4(3):183-187. Focal high intensity focused ultrasound of unilateral localized prostate cancer: a prospective multicentric hemiablation study of 111 patients. 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 . AIUM practice guideline for the performance of obstetric ultrasound examinations. 2004; 7(4):289-294. Primary pain palliation and local tumor control in bone metastases treated with magnetic resonance-guided focused ultrasound. An obstetrical ultrasound in the second or third trimester includes an evaluation of fetal number, cardiac activity, presentation, amniotic fluid volume, placental position, fetal biometry, and an anatomic survey. In an intent-to-treat analysis, 63% (72/115) were reported to have a complete histological response and had no evidence of cancer. . 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. 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). 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. The majority of attributable AEs were grade 1 or 2. 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. Available at: Testing for Zika Virus Infections. Updated September 20, 2021. 2015; 102(3):182-193. Reviewed and validity confirmed 2011. 2001; 15(4):437-440. 2011; 185(4):1246-1254. Anthem - Blue Cross Blue Shield Long awaited and much anticipated? The resulting heat and cavitation destroys the targeted tissue. Accessed on September 13, 2022. Taneja SS. Ultrasound abnormalities have been detected in the fetus from 2 to 29 weeks after symptom onset, and therefore, insufficient data are available to define the optimal timing between exposure and initial sonographic screening. Ultrasound in pregnancy. Available at: Second and third trimester screening for fetal anomaly. Lawrentschuk N, Finelli A, Van der Kwast TH, et al. 2015; 2015(6):CD001451. Ahmed HU, Cathcart P, McCartan N, et al. There is insufficient evidence to draw conclusions about the effect of HIFU on urinary incontinence, erectile dysfunction or fecal incontinence when compared to radical prostatectomy. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. 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. Sofuni A, Moriyasu F, Sano T, et al. Subtle second-trimester ultrasound markers should be interpreted in the context of a background risk based on the patients age, history, genetic screening, and serum screening results. 2011; 3(3):329-338. 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. Ahmed HU, Zacharakis E, Dudderidge T, et al. Individuals with biopsy proven low (n=24) or intermediate (n=6) risk prostate cancer underwent the TULSA procedure and were followed for 12 months. Rejection notice to me (if I'm lucky) and I start over. Gelet A, Chapelon JY, Poissonnier L, et al. 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. The price of a diagnostic mammogram averages from $172 under Medicare to $239 with private insurance. This document addresses ultrasound ablative therapy for the treatment of oncologic conditions. Zip Code or City, State . 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). Our radiologists are among the most . 2020; 22:79-87. Providers are responsible for billing the appropriate CPT code, modifier, and diagnosis combinations. Therapies for clinically localized prostate cancer [Internet]. Pregnant Women. TULSA is considered not medically necessary for any indication, including but not limited to prostate cancer. Focal therapy with high-intensity-focused ultrasound in the treatment of localized prostate cancer. Chen L, Wang K, Chen Z, et al. Focal therapies are proposed as less invasive treatment options when compared to radical prostatectomy or radiation therapy. 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. *Coverage includes fertility preservation . Participants were followed for up to 5 years post-procedure. Kanthabalan A, Peters M, Van Vulpen M, et al. 2014; 7(4):270-281. ACR Appropriateness Criteria. TULSA is delivered by a system which includes real-time MR thermometry as well as robotically-driven directional thermal ultrasound in a closed loop system to ablate whole gland or targeted areas of the prostate. J Urol. 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 . Gardner TA, Koch MO. 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. Indiana Medicaid provides coverage to pregnant women through two programs. Coverage varies some from plan to plan, so check your plan's specifics. 2021: S1078-1439(21)00173-3. 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). Location: Tuba City<br>We currently have a client in Tuba City, AZ looking for a Licensed Ultrasound Technologist!<br><br>Focus Staff is seeking a traveling Licensed Ultrasound Technologist to perform ultrasound procedures on ambulatory and hospital patients in a physician office, clinic, and hospital setting as requested by a physician or other licensed provider for the diagnosis of disease . CA/SG/Anthem Platinum PPO 15/250/10%/6BPB/01-22 Page 1 of 13 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: PPO Anthem Platinum PPO 15/250/10% The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. But in general, know that most plans cover: STD testing; Rh incompatibility testing; Prenatal vitamins; Gestational diabetes testing; Breastfeeding counseling and equipment; Post-birth birth control; Birth; Medical coverage of any complications; Dependent Care Accounts Contact us today for information about Anthem or for questions regarding Medicaid programs and coverage. Find a doctor near you. Anttinen M, Mkel P, Viitala A, et al. Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline. High-intensity focused ultrasound for the treatment of localized prostate cancer: 5-year experience. 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. And local tumor Control in bone metastases: effectiveness and feasibility rate monitoring Assess... 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