Boccon-Gibod L, Djavan WB, Hammerer P, et al. Available at: Second and Third Trimester Vaginal Bleeding. Focal salvage therapy for localized prostate cancer recurrence after external beam radiotherapy: a pilot study. Transrectal high-intensity focused ultrasound in the treatment of localized prostate cancer. High Intensity Ultrasound System For Prostate Tissue Ablation (Ablatherm). 2005; 4(3):187-192. The five HIFU trials included a total of only 136 individuals. HIFU has been proposed as a treatment for multiple oncologic conditions. Magnetic resonance-guided focused ultrasound for patients with painful bone metastases: phase III trial results. Int J Urol. NCCN Clinical Practice Guidelines in Oncology. 2010; 468(10):2825-2827. Eur Urol. Bone metastasis: When cancer cells have broken off from the primary tumor and have settled and started growing on bones. High intensity focused ultrasound (HIFU) or magnetic resonance guided focused ultrasound (MRgFUS) involves the use of a focused high-intensity convergent ultrasound beam to destroy targeted tissue in a small, focused area via sonication. Last Reviewed: August 25, 2022. To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the member's card. For more information about your rights, look at the explanation of benefits you will receive for that medical claim. That coverage comes at a cost, however; specifically, Plan F is the most expensive of all the MedSup policies on the market today. Moved content of MED.00119 High Intensity Focused Ultrasound (HIFU) for Oncologic Indications to new clinical utilization management guideline document with the same title. Ultrasound examinations can be used to assess fetal anatomy, particularly neuroanatomy, and to monitor growth. Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline. 2008; 102(7):786-792. 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. 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. High-intensity focused ultrasound and localized prostate cancer: efficacy results from the European multicentric study. Int J Urol. BJU Int. Updated Description, Coding, Discussion and References sections. Clin Orthop Relat Res. Uddin Ahmed H, Cathcart P, Chalasani V, et al. * Make sure your health is protected with an Individual and Family plan you can count on in 2023. The majority of attributable AEs were grade 1 or 2. Indiana Medicaid for Members. Updated References and Websites for additional information sections. Jpn J Clin Oncol. MRI-TULSA resulted in an 88% reduction of viable prostate tissue volume. J Pharm Bioallied Sci. There are currently more than 125 Treatment Centers around the world using Insightec's Exablate Neuro platform to treat Essential Tremor. In some states, insurance must cover . 2017; 197(1):97-102. AIUM-ACR-ACOG-SMFM-SRU Practice parameter for the performance of standard diagnostic obstetric ultrasound examinations. Gelet A, Chapelon JY, Poissonnier L, et al. ACOG Practice Bulletin Number 183, October 2017. The prospective, nonrandomized, investigator-initiated, single-arm, single-center phase 1 study included 11 individuals with localized, histopathologically verified, radio-recurrent prostate cancer. Available at. In brief: classifications in brief: Mirels' classification: metastatic disease in long bones and impending pathologic fracture. 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. Available at: Limited obstetrical ultrasound examination. Pregnant Women. MPTAC review. This document does not address nuchal translucency. Nair SM, Hatiboglu G, Relle J, et al. 2017; 71(2):267-273. Available at: Testing for Zika Virus Infections. Crouzet S, Blana A, Murat FJ, et al. A total of 29 individuals underwent a follow-up biopsy, either at 12 months only, or at 12 and 36 months. ACR Appropriateness Criteria. J Urol. When high-intensity ultrasound waves are used in place of low-intensity, body tissue absorbs, rather than reflects the energy. NOTE: Information about the cost of this plan (called the premium) will be . A total of 23 studies comprised of 1157 individuals were included. Ahmed HU, Freeman A, Kirkham A, et al. High-intensity focused ultrasound for treatment of pancreatic cancer: a systematic review. 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. Focal therapies are proposed as less invasive treatment options when compared to radical prostatectomy or radiation therapy. $0 plans in select areas. Participants were followed for up to 5 years post-procedure. Palliative Care. 2016; 70(3):447-455. Coverage varies some from plan to plan, so check your plan's specifics. The value of adding a universal booking scan to an existing protocol of routine mid-gestation ultrasound scan. Researchers used the visual analog pain score (VAS) to measure pain levels. The current evidence does not show that clinical outcomes of those undergoing TULSA is similar to those undergoing established alternatives. 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. Updated Coding section with 10/01/2022 ICD-10-CM changes; added O35.00X0-O35.9XX9 replacing O35.0XX0-O35.9XX9. 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. 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). 2016; 19(3):311-316. Taneja SS. Magnetic resonance imaging-guided transurethral ultrasound ablation of prostate cancer. Chin JL, Billia M, Relle J, et al. Kaur A, Kaur A. Transvaginal ultrasonography in first trimester of pregnancy and its comparison with transabdominal ultrasonography. In 2013, Napoli and colleagues treated 18 individuals with painful bone metastases with MRgFUS. Available at: Centers for Disease Control and Prevention (CDC). Grade 3 (n=1) and grade 2 (n=3) AEs related to urinary retention and urinary tract infection were reported. This study was defined by the regulatory agency to evaluate the effectiveness of the device to ablate prostate tissue. Re: Salvage high-intensity focused ultrasound for patients with recurrent prostate cancer after brachytherapy. Added not medically necessary statement for TULSA. 2006a; 13(3):228-233. July 25, 2018. Rejection notice to me (if I'm lucky) and I start over. MPTAC review. Transrectal high-intensity focused ultrasound: minimally invasive therapy of localized prostate cancer. Peek and associates (2015) conducted a systematic review of the use of HIFU in breast cancer. Ultrasound Obstet Gynecol. Siddiqui KM, Billia M, Arifin A, et al. Due to variances in utilization patterns, each plan may choose whether to adopt a particular Clinical UM Guideline. 2021; 127(5):544-552. 1999a; 54(2):273-277. Medical Encyclopedia. December 2016. Approximately 30% of all individuals with cancer develop metastatic bone lesions and 50-75% of these individuals report significant pain. 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. Focused ultrasound for the treatment of bone metastases: effectiveness and feasibility. 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). Centers for Disease Control and Prevention (CDC). Crouzet S, Murat FJ, Pommier P, 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. 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. 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. Accessed on September 13, 2022. The updated file enables providers to separately bill for the professional component (26) and the technical component (TC). Shoji S, Nakano M, Nagata Y, et al. Therapies for clinically localized prostate cancer [Internet]. 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. 2004; 63(4):625-629. 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. Updated Coding section with additional diagnosis codes D25.0-D25.9, O26.872-O26.879, O99.210-O99.213, O99.810. A statistically significant pain response was reported in 70.7% of this group. Salvage radical prostatectomy following primary high intensity focused ultrasound for treatment of prostate cancer. 2022 Prenatal ultrasound diagnosis (Dx) codes Please note that this information is a guideline. Chen L, Wang K, Chen Z, et al. Anthem has begun denying coverage for . Clarification to Not Medically Necessary Statement. It is likely that both of these treatment effects contribute to pain relief. Updated September 20, 2021. Ultrasound: A screening or diagnostic technique in which very high frequency sound waves are passed into the body, and the reflected echoes are detected and analyzed to build a picture of the internal organs or of a single fetus or multiple fetuses in the uterus. 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. Principles and results of high-intensity focused ultrasound for localized prostate cancer. American College of Radiology (ACR). 2004; 63(2):297-300. This document addresses the use of maternity ultrasound in the outpatient setting. 2012; 13(6):622-632. Jawad MU, Scully SP. MPTAC review. Book an appointment today! Day 1 health insurance coverage and comprehensive benefits options 401(k) matching program Summary of Safety and Effectiveness Data (SSED). The difference in response rates between MRgFUS and placebo at 3 months was significant (64.3% versus 20.0%). Real-time magnetic resonance-guided high-intensity focused ultrasound focal therapy for localised prostate cancer: preliminary experience. Hoosier Healthwise. Dupr A, Melodelima D, Prol D, et al. You can choose your preferred appointment time on our website, www.ultrasound-first.com, or you can call Lexie at the office (314-782-2034) if you need help or have any questions. 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. Accessed on October 20, 2022. Local recurrence of prostate cancer after external beam radiotherapy: early experience of salvage therapy using high-intensity focused ultrasonography. Ideally the ultrasound is done at the same appointment as the screening mammogram. Hemi salvage high-intensity focused ultrasound (HIFU) in unilateral radiorecurrent prostate cancer: a prospective two-centre study. Palermo G, Totaro A, Sacco E, et al. . Contact us today for information about Anthem or for questions regarding Medicaid programs and coverage. Postpartum hemorrhage. There was 1 in-field and 2 out-of-field recurrences reported at that time. Late complications included occurrences of stenosis (9%) and fistula (0.4%). 2005; 2(4):191-198. J Endourol. 2012; 118(12):3071-3078. In November, the FDA approved the use of Ablatherm (Maple Leaf; Toronto, Canada) to treat prostate cancer in individuals who previously failed radiation therapy. Available at: ACOG. The identified primary endpoint was the improvement in self-reported pain score without an increase in pain medication utilization at 3 months. 2017; 31(1):14-19. 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