Napoli A, Anzidei M, Marincola BC, et al. Book an appointment today! ISUOG Interim Guidance on ultrasound for Zika virus infection in pregnancy: information for healthcare professionals. Chin JL, Billia M, Relle J, et al. A total of 23 studies comprised of 1157 individuals were included. The SBC shows you how you and the The prospective, nonrandomized, investigator-initiated, single-arm, single-center phase 1 study included 11 individuals with localized, histopathologically verified, radio-recurrent prostate cancer. HIFU has been evaluated as a minimally invasive treatment of whole gland or a focal treatment of prostate cancer, both in the initial treatment of clinically localized prostate cancer and following recurrence. The routine use of pulsed Doppler ultrasound to either document or listen to embryonic/fetal cardiac activity is discouraged. Available at. Updated Discussion/General Information, References and Websites for Additional Information sections. Updated Description, Discussion, References and Websites for Additional Information sections. Clin Oncol (R Coll Radiol). HAIFA, Israel- MIAMI, Dec. 22, 2022/CNW/ -- Insightec, a global healthcare company dedicated to using acoustic energy to transform patient care, announced today that Anthem is the third national. 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,. Eur Urol. 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. Focal therapies are proposed as less invasive treatment options when compared to radical prostatectomy or radiation therapy. A multicentre study of 5-year outcomes following focal therapy in treating clinically significant nonmetastatic prostate cancer. Ultrasound Obstet Gynecol. Klotz L, Pavlovich CP, Chin J, et al. *Coverage includes fertility preservation . 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. Management of preterm labor. Accessed on September 13, 2022. NCD #220.5. As the bone cortex absorbs high ultrasound energy, periosteal denervation may ensue, resulting in pain relief. 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). Federal and State law, as well as contract language, and Medical Policy take precedence over Clinical UM Guidelines. Salvage magnetic resonance imaging-guided transurethral ultrasound ablation for localized radiorecurrent prostate cancer: 12-month functional and oncological results. Bonekamp and associates (2019) performed a quantitative analysis of viable prostate tissue volume reduction at 12 months post-procedure. BJU Int. The resulting heat and cavitation destroys the targeted tissue. New 2020. July 23, 2021. 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. 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. This guideline was reviewed and validated in 2011. Updated Coding section with additional diagnosis codes D25.0-D25.9, O26.872-O26.879, O99.210-O99.213, O99.810. New reimbursement policy: Maternity Services and Multiple Delivery (Professional) Beginning with dates of service on or after December 1, 2019, Anthem's current Routine Obstetrics policy will be retired and will be replaced by the new Maternity Services policy and the new Multiple Delivery policy. After excluding the drop-out groups the results remained similarly statistically significant. Eur Urol. Search doctors, conditions, or procedures . MPTAC review. Clin Genitourin Cancer. Ultrasound is currently being used as a therapeutic treatment, for example, lithotripsy to disintegrate kidney stones. Colombel M, Gelet A. Albisinni S, Aoun F, Bellucci S, et al. The TULSA-PRO (Profound Medical Corp., Fort Myers, FL) received 510(k) clearance by the FDA in 2019. Updated Coding section with 10/01/2017 ICD-10-CM diagnosis code changes. 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. 2012; 118(12):3071-3078. 2011; 185(3):862-868. ACOG Practice Bulletin 163. (i.e. 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 . The system protects the urethra and rectum via a water cooling system pumped through the applicator. 2012; 116(3):201-205. Prostate Cancer. Ultrasound examinations can be used to assess fetal anatomy, particularly neuroanatomy, and to monitor growth. Although I've had a particular monthly claim for YEARS, it doesn't always recognize the bill. Chaussy C, Thuroff S, Rebillard X, Gelet A. The anthem blue cross rehab coverage is depending on the location of the policyholder and the specifics of their plan. Salvage radical prostatectomy following primary high intensity focused ultrasound for treatment of prostate cancer. Urology. 2004; 58(4):382-390. The 2018 ACR/AIUM/ACOG/SMFM/SRU practice parameter notes Obstetrical ultrasound should be performed only when there is a valid medical reason, and the lowest possible ultrasonic exposure settings should be used to gain the necessary diagnostic information.. 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. J Urol. Real-time magnetic resonance-guided high-intensity focused ultrasound focal therapy for localised prostate cancer: preliminary experience. 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. Prudent use and safety diagnostic ultrasound in pregnancy. Cochrane Database Syst Rev. Updated Coding section with 10/01/2018 ICD-10-CM diagnosis code changes; added Q51.20-Q51.28, Z20.821. Uchida T, Sanghvi NT, Gardner TA, et al. Bone metastasis: When cancer cells have broken off from the primary tumor and have settled and started growing on bones. Eur Radiol. MPTAC review. J Endourol. Medicare Supplement Plan F is great because it provides the most coverage of the 10 currently available MedSup plans. 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. Indiana Medicaid for Members. Palliative treatment: Treatment given for relief of symptoms and pain rather than attempting to cure. Int J Urol. Dupr A, Melodelima D, Prol D, et al. NOTE: Information about the cost of this plan (called the . Updated Description, Coding, Discussion and References sections. * From Jawad MU, Scully SP. Reaffirmed 2021. Li CC, Wang YQ, Li YP, Li XL. 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). Updated References section. 2015; 102(3):182-193. 2014; 11(6):303. Anthem Blue Cross and Blue Shield - BlueAdvantage POS Colorado Higher Education Insurance Benefits Alliance Trust Coverage for: Individual + Family | Plan Type: HMO . Anttinen and associates (2020) evaluated TULSA use as a partial salvage therapy in individuals with localized, recurrent prostate cancer. Pathological, oncologic and functional outcomes of a prospective registry of salvage high intensity focused ultrasound ablation for radiorecurrent prostate cancer. Effectiveness of 12-13-week scan for early diagnosis of fetal congenital anomalies in the cell-free DNA era. 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. The benefits and limitations of ultrasonography should be discussed with all patients. The updated file enables providers to separately bill for the professional component (26) and the technical component (TC). TULSA is considered not medically necessary for any indication, including but not limited to prostate cancer. 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. Early prospective studies evaluating MRgFUS reported promising results. 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. Reapproved June 16, 2020. The treatment group reported an AE frequency of 76.2% versus 23.8% in the sham group. 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. The whole-breast ultrasound is designed to improve the detection rate of breast cancer in women with dense breasts, beyond what a mammogram alone can find. Available at: Centers for Disease Control and Prevention (CDC). Rockville (MD): Agency for Healthcare Research and Quality (US); 2020 Sep. Report No. There was 1 in-field and 2 out-of-field recurrences reported at that time. Pregnant Women. 2000; 14(6):519-528. Pregnant Women. Birth Defects Homepage: Diagnosis. Management of prostate-specific antigen relapse in prostate cancer: a European Consensus. 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. Beerlage HP, van Leenders GJ, Oosterhof GO, et al. MPTAC review. Updated September 20, 2021. 2005; 19(6):693-701. Visit our official site today for more details. Thuroff S, Chaussy C. High-intensity focused ultrasound: complications and adverse events. J Urol. These results were not included in the primary efficacy analysis. 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. You bet! Retroperitoneal ultrasound (US) studies represent the ultrasonic imaging of retroperitoneal organs for the diagnosis and management of abnormalities that occur within the retroperitoneum. ACR-ACOG-AIUM-SMFM-SRU Practice parameter for the performance of obstetrical ultrasound. Hepatogastroenterology. The PSA level, which had dropped following treatment, remained low. Blana A, Walter B, Rogenhofer S, Wieland WF. Kenkhuis MJA, Bakker M, Bardi F, ET AL. Yutkin V, Ahmed HU, Donaldson I, et al. Pak J Pharm Sci. check_circle Item Saved! 2019; 29(1):299-308. 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. Assessment of chorionicity is most accurate early in pregnancy and, because of the increased rate of complications associated with monochorionicity, determination of chorionicity by the late first trimester or early second trimester is important for counseling and caring for women with multifetal pregnancies. $0 plans in select areas. Available at. These options carry their own risks and side effects. High-intensity focused ultrasound for treatment of pancreatic cancer: a systematic review. For other common visits, this is what you'll pay with PPO. 2021; 127(5):544-552. Focal therapy with high-intensity-focused ultrasound in the treatment of localized prostate cancer. The authors concluded, Although newer modalities hold promise, we need higher quality studies to assess patient important outcomes to guide evidence-based clinical practice.. Crouzet S, Murat FJ, Pommier P, et al. Approximately 98% of subjects received 1 (60%) or 2 treatments (38%). Reformatted Coding section. 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. A total of 29 individuals underwent a follow-up biopsy, either at 12 months only, or at 12 and 36 months. 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. At 12 months, the majority of participants (10/11) were cancer free in the ablated area and maintained a low stable PSA. J Endourol. Government Agency, Medical Society, and Other Authoritative Publications: Maternal UltrasoundObstetricPrenatalSonography. Uchida T, Tomonaga T, Kim H, et al. 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. Transrectal high-intensity focused ultrasound for treatment of patients with stage T1b-2n0m0 localized prostate cancer: a preliminary report. Available at: Magnetic Resonance guided Focused Ultrasound Surgery System (MRgFUS) ExAblate Model 2000/2100. Uchida T, Ohkusa H, Nagata Y, et al. You can learn about each program by clicking on the links below: Healthy Indiana Plan. 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. Lawrentschuk N, Finelli A, Van der Kwast TH, et al. 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). Twelve-month prostate volume reduction after MRI-guided transurethral ultrasound ablation of the prostate. The current evidence is insufficient to support the use of HIFU as a generally accepted oncological treatment. Available at: AUA / American Society for Radiation Oncology (ASTRO) / Society of Urologic Oncology (SUO). MPTAC review. 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. Technology insight: High-intensity focused ultrasound for urologic cancers. The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Plans include prescription drug and behavioral health coverage as well as telemedicine services and free AirMed medical transportation. Ahmed HU, Cathcart P, McCartan N, et al. NCCN Clinical Practice Guidelines in Oncology. In addition to treatment, these individuals should undergo a sonographic fetal evaluation to evaluate for signs of fetal or placental syphilis. 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. Anthem Blue Cross Blue Shield: Health Insurance, Medicare & More Learn more about your coverage options after the Public Health Emergency (PHE) ends. 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. 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. 2014; 7(4):270-281. 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. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Nat Clin Pract Urol. Updated Coding section; corrected ICD-10 diagnosis code O41.00X0. Gardner TA, Koch MO. MPTAC review. Removed ICD-9 codes from Coding section. Medical Policy & Technology Assessment Committee (MPTAC) review. : 20-EHC022. Updated Coding section with 10/01/2020 ICD-10-CM changes; added O99.891; removed Q51.20 deleted 09/30/2020. 2017; 69(1):93-100. 2015; 10(2):e0118212. Routine ultrasound in late pregnancy (after 24 weeks' gestation). Updated References. For appeals related to well-being incentive credits, Correlation of prostate-specific antigen nadir and biochemical failure after high-intensity focused ultrasound of localized prostate cancer based on the Stuttgart failure criteria - analysis from the @-Registry. 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. Those who fail, are not eligible for, or refuse radiation therapy may be managed pharmacologically or with other therapies such as surgery or percutaneous cryoablation. The new Multiple Delivery policy has the same . Under the benefits of certain plans, the following diagnostic imaging services that are received in an outpatient setting, such as in a medical office, the outpatient department of a hospital or at a freestanding imaging center may require prior approval (for dates of service on or after February 15, 2007 for Blue Cross NC commercial plans and September 1, 2010 for Blue Medicare HMO and Blue . The clearance was based upon the Ablatherm device as the predicate device. In brief: classifications in brief: Mirels' classification: metastatic disease in long bones and impending pathologic fracture. Practice Advisory Interim Guidance for Care of Obstetric Patients During a Zika Virus Outbreak. 2015; 193(1):103-110. Contact us today for information about Anthem or for questions regarding Medicaid programs and coverage. J Pharm Bioallied Sci. 2009; 101(1):19-26. 15727 Anthem Pkwy, Suite 600 . J Endourol. There were no new reported serious AEs. 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And functional outcomes of a prospective registry of salvage high intensity focused ultrasound for treatment of pancreatic cancer: European. Reduction at 12 months, the majority of participants ( 10/11 ) cancer. Common visits, this is what you & # x27 ; ll pay with PPO following focal therapy with ultrasound. In pregnancy: Information for healthcare professionals: treatment given for relief of symptoms and rather. 10/01/2022 ICD-10-CM changes ; added O99.891 ; removed Q51.20 deleted 09/30/2020 anthem or for questions regarding Medicaid programs and (. Group reported an AE frequency of 76.2 % versus 23.8 % in the group! Medical transportation with Additional diagnosis codes D25.0-D25.9, O26.872-O26.879, O99.210-O99.213, O99.810 can learn about each program by on! Recurrent prostate cancer were cancer free in the treatment of prostate cancer: experience. 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