Reformatted Coding section. 2012; 13(6):622-632. 2015; 28(3 Suppl):1097-1100. Updated Description, Discussion, References and Websites for Additional Information sections. Available at: ACOG. Eur Urol. Chaussy C, Thuroff S. The status of high-intensity focused ultrasound in the treatment of localized prostate cancer and the impact of a combined resection. Available at: AUA / American Society for Radiation Oncology (ASTRO) / Society of Urologic Oncology (SUO). 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. J Urol. Before you decide to pass on Plan F, though, do your due diligence and see how much the insurance . Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. 2001; 15(4):437-440. Int J Clin Pract. MPTAC review. 2007; 51(2):381-387. 2011; 185(4):1246-1254. HIFU or MRgFUS has also been studied as a potential treatment of various cancers. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. 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. 2017; 119(6):896-904. 2021; 205(3):769-779. The anthem blue cross rehab coverage is depending on the location of the policyholder and the specifics of their plan. Effectiveness of 12-13-week scan for early diagnosis of fetal congenital anomalies in the cell-free DNA era. Liberman and associates (2009) used MRgFUS to treat 31 individuals with painful bone metastases who had exhausted or refused all other pain palliation methods. In a phase 1, single-arm, prospective study, Chin and colleagues (2016) evaluated the safety and feasibility of MRI guided TULSA. Hurwitz MD, Ghanouni P, Kanaev SV, 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). Reaffirmed October 2021. Eur Urol Open Sci. July 25, 2018. Uddin Ahmed H, Cathcart P, Chalasani V, et al. Available at. 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. 510K Premarket notification. However, residual tumors of less than 10% were found in 29.4% of cases and residual tumors between 10-90% were found in 22.7% of cases. J Ther Ultrasound. First trimester ultrasound tests alone or in combination with first trimester serum tests for Down's syndrome screening. Number 7. The baseline median PSA of 7.6 ng/ml decreased to 0.23 ng/ml at 12 months follow-up. Kenkhuis MJA, Bakker M, Bardi F, ET AL. Management of preterm labor. Shah TT, Peters M, Kanthabalan A, et al. In some states, insurance must cover . New 2020. Available at: Centers for Disease Control and Prevention (CDC). Magnetic resonance imaging-guided transurethral ultrasound ablation in patients with localised prostate cancer: 3-year outcomes of a prospective Phase I study. Prostate Cancer (V1.2023). The resulting heat and cavitation destroys the targeted tissue. Li CC, Wang YQ, Li YP, Li XL. Although I've had a particular monthly claim for YEARS, it doesn't always recognize the bill. AIUM Practice Parameter for the Performance of Detailed Diagnostic Obstetric Ultrasound Examinations Between 12Weeks 0Days and 13Weeks 6Days. The current evidence does not show that clinical outcomes of those undergoing TULSA is similar to those undergoing established alternatives. Cancer. Update date: March 4, 2022. The SBC shows you how you and the plan would share the cost for covered health care services. Thuroff S, Chaussy C. High-intensity focused ultrasound: complications and adverse events. 2015; 194(1):114. Pak J Pharm Sci. Reaffirmed 2018. Hoosier Healthwise. Zika virus was first reported in South America in May 2015 and since that time has now appeared in the United States. Zika Virus. 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. In 2016, ACOG and the SMFM released a practice advisory regarding the current information and recommendations regarding the Zika virus. In brief: classifications in brief: Mirels' classification: metastatic disease in long bones and impending pathologic fracture. Twelve-month prostate volume reduction after MRI-guided transurethral ultrasound ablation of the prostate. Available at: High Intensity Ultrasound System For Prostate Tissue Ablation (Focal One). MPTAC review. 2014; 106(5). 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. Updated September 20, 2021. Br J Cancer. 2015 Mar;34(3):435-440. 2008; 38(3):192-199. 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. ISUOG Interim Guidance on ultrasound for Zika virus infection in pregnancy: information for healthcare professionals. Participants included those who could not undergo or refused all other available options for pain palliation. Updated Coding section with 10/01/2020 ICD-10-CM changes; added O99.891; removed Q51.20 deleted 09/30/2020. We are now accepting all Anthem Blue Cross Blue Shield patients. In an intent-to-treat analysis, 63% (72/115) were reported to have a complete histological response and had no evidence of cancer. For appeals related to well-being incentive credits, Last Revised March 16, 2022. Approximately 30% of all individuals with cancer develop metastatic bone lesions and 50-75% of these individuals report significant pain. 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. Br J Surg. Liberman B, Gianfelice D, Inbar Y, et al. Hematology/Oncology Subcommittee review. Available at: U.S. National Library of Medicine. Eur Urol. 2005; 12(2):2593-2597. 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. 2015; 62(137):140-143. Updated References section. Ahhhhh! Medical Encyclopedia. In addition to the active and pending Medical Policies, BCBSIL has included policies which are under development or being revised. To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the member's card. Rooms for rent in Bury flat and house shares - 3 currently available. At 2 weeks follow-up, all individuals experienced a decrease in VAS pain scores from baseline (1.5-5). 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. Br J Surg. MPTAC review. 2016; 19(3):311-316. Alternatively, the reduced tumor mass caused by thermal ablation may have an analgesic effect. The document header wording updated from Current Effective Date to Publish Date. Updated Discussion/General Information, References and Websites for Additional Information sections. In 2015, The U.S. Food and Drug Administration (FDA) approved two devices for use in prostate cancer. High intensity focused ultrasound ablation for patients with inoperable liver cancer. Removed ICD-9 codes from Coding section. Improved outcomes with advancements in high intensity focused ultrasound devices for the treatment of localized prostate cancer. NCCN Clinical Practice Guidelines in Oncology. November 6, 2015. Updated Discussion/General Information and Reference sections. These Medical Policies serve as guidelines for health care benefit coverage decisions, which may vary according to the different products and benefit plans offered by BCBSIL. In October 2017, ACOG and SMFM released an updated version of the practice advisory based upon updated Centers for Disease Control and Prevention (CDC) recommendations and recently published guidance. August 27, 2020. Although the exact mechanism of analgesic action of MRgFUS in pain palliation is unknown, studies have pointed to a few explanations. Crouzet S, Blana A, Murat FJ, et al. Mol Urol. Anthem has begun denying coverage for . 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. American College of Radiology (ACR). Geiger D, Napoli A, Conchiglia A, et al. 2019; 29(1):299-308. Updated Discussion/General Information, References and Websites for Additional Information sections. October 2016. 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. 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 Urol. Influence of high intensity focused ultrasound (HIFU) treatment to the pancreatic function in pancreatic cancer patients. *Coverage includes fertility preservation . Evaluation of quality of life outcomes following palliative treatment of bone metastases with magnetic resonance-guided high intensity focused ultrasound: an international multicentre study. Transrectal high-intensity focused ultrasound: minimally invasive therapy of localized prostate cancer. American College of Obstetricians and Gynecologists (ACOG). Initial document development. Focal therapy for localized prostate cancer: a phase I/II trial. Urology. Control of prostate cancer by transrectal HIFU in 227 patients. The primary endpoint was achieved in 96% (110/115) of participants. Ultrasound in pregnancy. Available at: Centers for Disease Control and Prevention (CDC): How is Prostate Cancer Treated? Participants received either MRgFUS (n=112) or placebo (n=35) treatment. 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. The American College of Obstetricians and Gynecologists (ACOG) 2018 Practice Bulletin Ultrasound in Pregnancy lists the following recommendations: The following conclusions are based on good and consistent evidence (Level A): The following conclusions are based on limited or inconsistent evidence (Level B): The following conclusion and recommendation are based primarily on consensus and expert opinion (Level C): The American College of Radiology (ACR), the American Institute of Ultrasound in Medicine (AIUM), ACOG, the Society for Maternal Fetal Medicine (SMFM), and the Society of Radiologists in Ultrasound (SRU) practice parameter (2018) notes: A standard obstetrical ultrasound examination in the first trimester includes evaluation of the presence, size, location, and number of gestational sac(s). 1999b; 39(1):41-46. 2015; 102(3):182-193. Surgery: MRgFUS-non invasive treatment for patients with painful bone metastasis. August 15, 2019. Re: Salvage high-intensity focused ultrasound for patients with recurrent prostate cancer after brachytherapy. Hinyokika Kiyo. However, the change from baseline in MEDD intake was not statistically significant, although the authors noted a trend towards a statistically significant change. Magnetic resonance imaging-guided transurethral ultrasound ablation of prostate cancer. The sound wave echoes are recorded and displayed as a real-time visual image. 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. 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. 2021: S1078-1439(21)00173-3. 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 . High-intensity focused ultrasound and localized prostate cancer: efficacy results from the European multicentric study. High intensity focused ultrasound (HIFU): A surgical procedure that uses focused high energy sound waves to destroy target tissues in the body. Peek and associates (2015) conducted a systematic review of the use of HIFU in breast cancer. 2011; 108(8 Pt 2):E196-E201. Palermo G, Totaro A, Sacco E, et al. Uchida T, Ohkusa H, Yamashita H, et al. 2009; 16(1):140-146. Indiana Medicaid provides coverage to pregnant women through two programs. 2012; 116(3):201-205. The updated file enables providers to separately bill for the professional component (26) and the technical component (TC). Find top doctors who perform Rectal Ultrasound near you in Anthem, AZ. Accessed on October 20, 2022. 2010; 17(8):715-719. Individuals received either whole gland (n=8) or partial (n=8) ablation. Whole-gland salvage high-intensity focused ultrasound therapy for localized prostate cancer recurrence after external beam radiation therapy. National Coverage Determination: Ultrasound diagnostic procedures. Elterman D, Li W, Hatiboglu G, et al. Pregnant Women. 2014; 84(5):1157-1162. Participants were followed for up to 5 years post-procedure. Crouzet S, Chapelon JY, Rouvire O, et al. The authors noted that incomplete tumor ablation could be related to poor accuracy in determining the target area or movement during the procedure. : 20-EHC022. U.S. Food and Drug Administration (FDA). 2004; 63(4):625-629. This document addresses ultrasound ablative therapy for the treatment of oncologic conditions. Pain palliation in patients with bone metastases using magnetic resonance-guided focused ultrasound with conformal bone system: a preliminary report. Researchers used the visual analog pain score (VAS) to measure pain levels. Ultrasound examinations, particularly if obtained soon after onset of infection, may not identify prenatal features of congenital Zika syndrome and structural manifestations can be identified at later points in pregnancy. These resources can help members understand their maternity benefits. December 2016. Salvage high-intensity focused ultrasound for patients with recurrent prostate cancer after brachytherapy. The location you tried did not return a result. Updated References. NOTE: Information about the cost of this plan (called the . Urol Oncol. 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). Addition of cell-free fetal deoxyribonucleic acid (DNA) screening for aneuploidy to Medically Necessary Statement. (2018). Anttinen M, Mkel P, Viitala A, et al. The current evidence is insufficient to support the use of HIFU as a generally accepted oncological treatment. 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. Grade 3 (n=1) and grade 2 (n=3) AEs related to urinary retention and urinary tract infection were reported. Gelet A, Chapelon JY, Poissonnier L, et al. Salvage radical prostatectomy following primary high intensity focused ultrasound for treatment of prostate cancer. 2017; 3:CD012600. The price of a diagnostic mammogram averages from $172 under Medicare to $239 with private insurance. 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 . Book an appointment today! Treatment of localized prostate cancer using high-intensity focused ultrasound. Updated Description, Discussion, References and Websites for Additional Information sections. 2006b; 97(1):56-61. There are currently more than 125 Treatment Centers around the world using Insightec's Exablate Neuro platform to treat Essential Tremor. Revised title from High Intensity Focused Ultrasound (HIFU) for Oncologic Indications to Ultrasound Ablation for Oncologic Indications. Post-treatment biopsies were available in 77% of subjects. Updated Coding, Description, Discussion/General Information, and References. 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. Retroperitoneal ultrasound (US) studies represent the ultrasonic imaging of retroperitoneal organs for the diagnosis and management of abnormalities that occur within the retroperitoneum. HIFU has been proposed as a treatment for multiple oncologic conditions. Step 1: Report your pregnancy to your health plan. 2014; 11(6):303. Prudent use and safety diagnostic ultrasound in pregnancy. Available at. Eur Urol. Yonsei Med J. CO CHEIBA Custom Blue Priority PPO/BluePreferred Plan F 01 -20 1 of 15 Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2021- 12/31/2021 Anthem Blue Cross and Blue Shield: Prime Blue Priority PPO Single high intensity focused ultrasound session as a whole gland primary treatment for clinically localized prostate cancer: 10-year outcomes. Sonablate was classified as a class II device. Crouzet S, Murat FJ, Pommier P, et al. * From Jawad MU, Scully SP. June 2021. Gelet A, Chapelon JY, Bouvier R, et al. Ahmed HU, Cathcart P, McCartan N, et al. 2018; 51(4):463-469. 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. BJU Int. Bone Metastases. One ultrasound of a pregnant uterus per member, per routine course of care; Estimate gestational age for individuals with uncertain clinical dates. Thuroff S, Chaussy C, Vallancien G, et al. Updated Description, Discussion and References sections. Available at: Second and third trimester screening for fetal anomaly. 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. Temperatures within the targeted area increase to 60-95C, which destroys the targeted tissue without damaging the adjacent tissue. 2017; 69(1):93-100. MRI-TULSA resulted in an 88% reduction of viable prostate tissue volume. Systematic review of innovative ablative therapies for the treatment of locally advanced pancreatic cancer. Lancet Oncol. Locally recurrent prostate cancer after initial radiation therapy: early salvage high-intensity focused ultrasound improves oncologic outcomes. Albisinni S, Aoun F, Bellucci S, et al. 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.. 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. Shi Y, Ying X, Hu X, et al. Prostate Cancer Prostatic Dis. 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. The authors concluded, Although newer modalities hold promise, we need higher quality studies to assess patient important outcomes to guide evidence-based clinical practice.. 2016; 70(3):447-455. 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. 399 reviews of Anthem Blue Cross "Poor reviews for Anthem's medical insurance coverage business, in particular, the medical insurance processing. Ultrasound Obstet Gynecol. Muto S, Yoshii T, Saito K, et al. AIUM Practice Parameter for the Performance of Detailed Second- and Third-Trimester Diagnostic Obstetric Ultrasound Examinations. 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) Minerva Urol Nefrol. J Urol. Similar to prostate cancer, there is a lack of randomized trials comparing HIFU to standard treatment options. 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. J Endourol. Ultrasound Tech in San Antonio, Texas, United States. Prostate Cancer. 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. Insurance coverage for whole-breast ultrasound is evolving. MedlinePlus. Available at: Testing for Zika Virus Infections. 2021; 127(5):544-552. 2005; 51(10):651-658. There are currently two ultrasound ablative techniques. Available at: U.S. National Library of Medicine. 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.
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