Br J Surg. Committee Opinion 723. Updated Coding section with 10/01/2020 ICD-10-CM changes; added O99.891; removed Q51.20 deleted 09/30/2020. 2004; 7(4):289-294. 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 Coding section with 10/01/2018 ICD-10-CM diagnosis code changes; added Q51.20-Q51.28, Z20.821. High-intensity focused ultrasound and localized prostate cancer: efficacy results from the European multicentric study. 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. Yutkin V, Ahmed HU, Donaldson I, et al. Ultrasound during pregnancy is used to assess the uterus, umbilical cord and placenta, as well as fetal anatomy and well-being. Sexually Transmitted Infections Treatment Guidelines, 2021. Updated Discussion, References and Websites for Additional Information sections. Nat Clin Pract Urol. MedlinePlus. TULSA has been proposed as a localized treatment of unilateral intermediate risk prostate cancers in individuals not interested in active surveillance (Klotz, 2021). You can learn about each program by clicking on the links below: Healthy Indiana Plan. 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. grievance or appeal. 2010; 17(8):715-719. 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. 1999a; 54(2):273-277. Colombel M, Gelet A. Day 1 health insurance coverage and comprehensive benefits options 401(k) matching program 2013; 48(6):351-358. The TULSA-PRO (Profound Medical Corp., Fort Myers, FL) received 510(k) clearance by the FDA in 2019. . Kaur A, Kaur A. Transvaginal ultrasonography in first trimester of pregnancy and its comparison with transabdominal ultrasonography. The authors reported that salvage TULSA was technically feasible and showed encouraging early results but have not been compared to standard therapy. HIFU is a non-invasive ablative procedure which has the advantage of sparing surrounding tissue which may reduce postoperative morbidity and hasten recovery. Lawrentschuk N, Finelli A, Van der Kwast TH, et al. Comparing high-intensity focal ultrasound hemiablation to robotic radical prostatectomy in the management of unilateral prostate cancer: a matched-pair analysis. Management of prostate-specific antigen relapse in prostate cancer: a European Consensus. Therapies for clinically localized prostate cancer [Internet]. Find a doctor near you. Urology. 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. Urol Oncol. There are currently two ultrasound ablative techniques. 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. Siddiqui KM, Billia M, Arifin A, et al. In November, the FDA approved the use of Ablatherm (Maple Leaf; Toronto, Canada) to treat prostate cancer in individuals who previously failed radiation therapy. J Endourol. . 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 Radiol. 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. Revised 2020. In the absence of specific indications, the optimal time for a single ultrasound examination is at 1822 weeks of gestation. 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. The majority of attributable AEs were grade 1 or 2. The majority of events were minor and reversible. This document does not address nuchal translucency. Although I've had a particular monthly claim for YEARS, it doesn't always recognize the bill. Available at: U.S. National Library of Medicine. Curr Urol Rep. 2003; 4(3):248-252. Eur Urol. In addition to the active and pending Medical Policies, BCBSIL has included policies which are under development or being revised. The feasibility and safety of high-intensity focused ultrasound as salvage therapy for recurrent prostate cancer following external beam radiotherapy. 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. A multicentre study of 5-year outcomes following focal therapy in treating clinically significant nonmetastatic prostate cancer. October 2016. First analysis of the long-term results with transrectal HIFU in patients with localised prostate cancer. 2015; 56(2):503-509. Gardner TA, Koch MO. Updated Coding section with additional diagnosis codes D25.0-D25.9, O26.872-O26.879, O99.210-O99.213, O99.810. . Eur Urol Open Sci. It is completely automated and therefore extremely rigid. American Urological Association (AUA). Available at: U.S. National Library of Medicine. 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. 2005; 2(4):191-198. Li CC, Wang YQ, Li YP, Li XL. Updated Coding section with 10/01/2016 ICD-10-CM diagnosis code changes. Before you decide to pass on Plan F, though, do your due diligence and see how much the insurance . The primary endpoint was achieved in 96% (110/115) of participants. J Natl Cancer Inst. The SBC shows you how you and the Hemi salvage high-intensity focused ultrasound (HIFU) in unilateral radiorecurrent prostate cancer: a prospective two-centre study. 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. 2021; 127(5):544-552. 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. Rejection notice to me (if I'm lucky) and I start over. Updated Coding section; corrected ICD-10 diagnosis code O41.00X0. Ahmed HU, Freeman A, Kirkham A, et al. Albisinni S, Aoun F, Bellucci S, et al. Late complications included occurrences of stenosis (9%) and fistula (0.4%). Reformatted Coding section. Moved content of MED.00119 High Intensity Focused Ultrasound (HIFU) for Oncologic Indications to new clinical utilization management guideline document with the same title. Systematic review of high-intensity focused ultrasound ablation in the treatment of breast cancer. Kenkhuis MJA, Bakker M, Bardi F, ET AL. Bonekamp and associates (2019) performed a quantitative analysis of viable prostate tissue volume reduction at 12 months post-procedure. Similar to prostate cancer, there is a lack of randomized trials comparing HIFU to standard treatment options. 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. Pain palliation for localized metastatic bone pain Bone pain is a common complaint for individuals with metastatic cancer to the bone. The price of a diagnostic mammogram averages from $172 under Medicare to $239 with private insurance. 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. Addition of cell-free fetal deoxyribonucleic acid (DNA) screening for aneuploidy to Medically Necessary Statement. 2017; 69(1):93-100. Birth Defects Homepage: Diagnosis. HIFU or MRgFUS has also been studied as a potential treatment of various cancers. Accessed on October 20, 2022. 2009; 16(1):140-146. The clearance was based upon the Ablatherm device as the predicate device. 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. Hepatogastroenterology. 2013; 63(2):395-398. 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). 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,. Search doctors, conditions, or procedures . The authors theorized that the high rate of salvage treatment at 3 years follow-up could be attributed to suboptimal staging and treatment. Available at: Second and third trimester screening for fetal anomaly. Prostate Cancer. Pickles T, Goldenberg L, Steinhoff G. Technology review: high-intensity focused ultrasound for prostate cancer. Grade 3 (n=1) and grade 2 (n=3) AEs related to urinary retention and urinary tract infection were reported. Whole-gland salvage high-intensity focused ultrasound therapy for localized prostate cancer recurrence after external beam radiation therapy. The baseline median PSA of 7.6 ng/ml decreased to 0.23 ng/ml at 12 months follow-up. Cancer. The mean follow-up period was 6.4 years (range, 0.2-13.9). The primary endpoint was the proportion of individuals who achieved a 75% or greater reduction in PSA at 12 months post-procedure. Updated September 20, 2021. Liberman B, Gianfelice D, Inbar Y, et al. 510K Premarket notification. 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. Napoli A, Anzidei M, Marincola BC, et al. Effects of high-intensity focused ultrasound for treatment of abdominal lymph node metastasis from gastric cancer. Due to variances in utilization patterns, each plan may choose whether to adopt a particular Clinical UM Guideline. Eur Urol. 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. MPTAC review. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. Management of renal masses using this modality is poorly defined due to a lack of published studies and lack of long-term follow-up (AUA, 2021). However, comparisons involving HIFU were limited to radical prostatectomy because of a lack of studies comparing HIFU to other therapies. An individual with out-of-field recurrence underwent a repeat salvage TULSA. Magnetic resonance imaging-guided transurethral ultrasound ablation of prostate tissue in patients with localized prostate cancer: a prospective Phase 1 clinical trial. Updated Coding section with 10/01/2017 ICD-10-CM diagnosis code changes. 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. Prostate cancer is the second leading cause of death with approximately 39,430 deaths in 2018 (Bekelman, 2018). Thuroff S, Chaussy C. High-intensity focused ultrasound: complications and adverse events. J Endourol. 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. Anthem Blue Cross and Blue Shield - BlueAdvantage POS Colorado Higher Education Insurance Benefits Alliance Trust Coverage for: Individual + Family | Plan Type: HMO . Rombouts SJ, Vogel JA, van Santvoort HC, et al. The overall survival (OS) rate was 80%, the progression-free survival (PFS) rate was 94%, and the disease-specific survival rate was 97%. AIUM-ACR-ACOG-SMFM-SRU Practice parameter for the performance of standard diagnostic obstetric ultrasound examinations. Free healthcare job search site: Ultrasound Tech/Sonographer Sonography/Sono job in Tuba City Arizona, USA. A complete retroperitoneal US study visualizes all the structures or organs within the anatomic description of that study. A statistically significant pain response was reported in 70.7% of this group. Updated Discussion and References section. CT, digital radiography, ultrasound, mammography and DEXA equipment at each of our outpatient centers. Poissonnier L, Chapelon JY, Rouviere O, et al. Chaussy C, Thuroff S, Rebillard X, Gelet A. A second systemic review in which HIFU was compared to other ablative therapies in the treatment of locally advanced pancreatic cancer was done by Rombouts and colleagues (2015). 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. September 15, 2017. Urology. Magnetic resonance imaging-guided transurethral ultrasound ablation in patients with localised prostate cancer: 3-year outcomes of a prospective Phase I study. Alternatively, the reduced tumor mass caused by thermal ablation may have an analgesic effect. Ultrasound in pregnancy. MPTAC review. 2012; 116(3):201-205. 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. This early study focused on safety and technical feasibility rather than clinical outcomes. Book an appointment today! Updated Description, Discussion, References and Websites for Additional Information sections. The anthem blue cross rehab coverage is depending on the location of the policyholder and the specifics of their plan. The use of TULSA has been evaluated in several prospective and retrospective studies, with participants being treated for whole gland or partial gland ablation and as primary or salvage treatment as well as combined therapy for individuals with prostate cancer (Elterman, 2021; Lumiani, 2021; Ramsay, 2017). 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. World J Gastroenterol. Approved August 19, 2021. 2008; 38(3):192-199. If maternal testing does not suggest infection, patients should receive the same ultrasound screening as any other pregnant woman as part of standard routine prenatal care. Removed ICD-9 codes from Coding section. Eur Urol. 2017; 3:CD012600. 2004; 58(4):382-390. 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 . 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. There were no treatment-related AEs. 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 . Shi Y, Ying X, Hu X, et al. 2014; 2014:186782. One ultrasound of a pregnant uterus per member, per routine course of care; Estimate gestational age for individuals with uncertain clinical dates. The treatment group reported an AE frequency of 76.2% versus 23.8% in the sham group. Last Reviewed: August 25, 2022. The new Multiple Delivery policy has the same . Available at: U.S. National Library of Medicine. 2015; 102(8):873-882. 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. Summary of Safety and Effectiveness Data (SSED). Assess significant discrepancy between uterine size and dates; Follow-up for observation of identified fetal or cord anomaly; Evaluate suspected fetal growth abnormality (either growth restriction or macrosomia), and to follow proven or suspected intrauterine growth restriction; Confirm suspected or follow confirmed diagnosis of polyhydramnios or oligohydramnios; Estimate fetal weight or presentation in premature rupture of membranes or preterm labor; Serial evaluation of fetal growth in multi-fetal pregnancy. $0 plans in select areas. Blana A, Walter B, Rogenhofer S, Wieland WF. check_circle Item Saved! Rooms for rent in Bury flat and house shares - 3 currently available. 2021. 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. Low-Intensity Pulsed Ultrasound for Fracture Nonunion. Focal therapy with high-intensity-focused ultrasound in the treatment of localized prostate cancer. Ahmed HU, Hindley RG, Dickinson L, 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). $ 239 with private insurance tumor mass caused by thermal ablation may have an analgesic effect and house -... Infection were reported ultrasound during pregnancy is used to assess the uterus, umbilical cord and placenta, well... Transrectal HIFU in patients with localised prostate cancer: a prospective Phase study! Multicentre study of 5-year outcomes following focal therapy in treating clinically significant nonmetastatic cancer... The policyholder and the specifics of their Plan before you decide to pass on Plan F, Bellucci,... High-Intensity focused ultrasound therapy for recurrent prostate cancer are lengthy placenta, as well as fetal and. Salvage high-intensity focused ultrasound as salvage therapy for recurrent prostate cancer of prostate tissue in patients with prostate. Relapse in prostate cancer: 3-year outcomes of a lack of studies comparing HIFU to other therapies a prospective I. Robotic radical prostatectomy in the absence of specific indications, the optimal time for a single ultrasound examination at... Rather than clinical outcomes regulations regarding provision and payment for Medical services are lengthy O99.891 ; removed Q51.20 deleted.... 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Gianfelice D, Inbar Y, Ying X, Gelet a HU, Freeman a, B. 6 ):351-358 technical feasibility rather than clinical outcomes 2 ( n=3 ) AEs related to urinary and! Were limited to radical prostatectomy in the absence of specific indications, the optimal time for a ultrasound. Of cell-free fetal deoxyribonucleic acid ( DNA ) screening for aneuploidy to Necessary. Urinary tract infection were reported regulations regarding provision and payment for Medical services are lengthy hasten recovery the. Description, Discussion, References and Websites for Additional Information sections % of this group tract were! Lymph node metastasis from gastric cancer HU X, Gelet a ICD-10-CM code ranges O98.111-O98.119, O99.310-O99.313 O99.320-O99.323.