Available at: Testing for Zika Virus Infections. At various gestational ages, ultrasound examination is an accurate method of determining gestational age, fetal number, viability, and placental location, and it is recommended for all pregnant patients. The authors reported that salvage TULSA was technically feasible and showed encouraging early results but have not been compared to standard therapy. Nair SM, Hatiboglu G, Relle J, et al. These options carry their own risks and side effects. They determined that Cloyd had ovarian cysts, not appendicitis. J Urol. Revised title from High Intensity Focused Ultrasound (HIFU) for Oncologic Indications to Ultrasound Ablation for Oncologic Indications. 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. Sofuni A, Moriyasu F, Sano T, et al. NOTE: Information about the cost of this plan (called the premium) will be . The recommendations are based on limited data. 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. Addition of cell-free fetal deoxyribonucleic acid (DNA) screening for aneuploidy to Medically Necessary Statement. Influence of high intensity focused ultrasound (HIFU) treatment to the pancreatic function in pancreatic cancer patients. Focused ultrasound for the treatment of bone metastases: effectiveness and feasibility. In the absence of specific indications, the optimal time for a single ultrasound examination is at 1822 weeks of gestation. ACOG Practice Bulletin 163. At 2 weeks follow-up, all individuals experienced a decrease in VAS pain scores from baseline (1.5-5). Rejection notice to me (if I'm lucky) and I start over. 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. 2007; 51(2):381-387. Ultrasound averages range from $54 to $100. 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. 2014; 65(5):907-914. Ultrasound is currently being used as a therapeutic treatment, for example, lithotripsy to disintegrate kidney stones. Comparing high-intensity focal ultrasound hemiablation to robotic radical prostatectomy in the management of unilateral prostate cancer: a matched-pair analysis. Approximately 98% of subjects received 1 (60%) or 2 treatments (38%). Before you decide to pass on Plan F, though, do your due diligence and see how much the insurance . June 7, 2018. Thuroff S, Chaussy C, Vallancien G, et al. 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. 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). 2014; 2014:186782. Updated: June 16, 2022. 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. Shah TT, Peters M, Kanthabalan A, et al. Yutkin V, Ahmed HU, Donaldson I, et al. The current standard treatment is external beam radiation therapy (EBRT). Medical Policy & Technology Assessment Committee (MPTAC) review. Indiana Medicaid for Members. AIUM Practice Parameter for the Performance of Detailed Diagnostic Obstetric Ultrasound Examinations Between 12Weeks 0Days and 13Weeks 6Days. While there is no reliable evidence to support ultrasounds performed during pregnancy will harm a fetus, there is general agreement that the casual use of ultrasonography during pregnancy should be avoided (ACOG, 2018). Revised September 16, 2022. 2000; 4(3):183-187. Participants received either MRgFUS (n=112) or placebo (n=35) treatment. 2015; 2015(7):CD007058. To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the member's card. 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. Salvage high-intensity focused ultrasound for patients with recurrent prostate cancer after brachytherapy. Nat Rev Clin Oncol. 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. 2021; 127(5):544-552. Magnetic resonance imaging-guided transurethral ultrasound ablation in patients with localised prostate cancer: 3-year outcomes of a prospective Phase I study. First analysis of the long-term results with transrectal HIFU in patients with localised prostate cancer. MPTAC review. Hurwitz MD, Ghanouni P, Kanaev SV, et al. Updated September 20, 2021. The authors noted that incomplete tumor ablation could be related to poor accuracy in determining the target area or movement during the procedure. 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) HAIFA, Israel - MIAMI, Florida (December 22, 2022) Insightec , a global healthcare company dedicated to using acoustic energy to transform patient care, announced today that Anthem is the third national payor to cover MR-guided Focused Ultrasound for treating medication-refractory Essential Tremor. Principles and results of high-intensity focused ultrasound for localized prostate cancer. Placenta Accreta Spectrum. Updated Coding section with 10/01/2020 ICD-10-CM changes; added O99.891; removed Q51.20 deleted 09/30/2020. Single high intensity focused ultrasound session as a whole gland primary treatment for clinically localized prostate cancer: 10-year outcomes. 2017. High-intensity focused ultrasound and localized prostate cancer: efficacy results from the European multicentric study. 2011; 185(3):862-868. Available at: Centers for Medicare and Medicaid Services. By March 2018, Anthem (Blue Cross/Blue Shield) will require that MR and CT scans considered "not medically necessary" be performed at freestanding medical imaging facilities in order to be covered. July 25, 2018. These resources can help members understand their maternity benefits. (i.e. Eur Radiol. 510K Premarket notification. Eligibility included those at least 18 years old with at least a 3-month life expectancy with bone metastases which were painful despite previous radiation therapy (RT) but unsuitable for further RT. Ultrasound is currently being used as a therapeutic treatment, for example, lithotripsy to disintegrate kidney stones. Improved outcomes with advancements in high intensity focused ultrasound devices for the treatment of localized prostate cancer. National Coverage Determination: Ultrasound diagnostic procedures. The overall survival (OS) rate was 80%, the progression-free survival (PFS) rate was 94%, and the disease-specific survival rate was 97%. Available at: American Institute of Ultrasound in Medicine (AIUM). Providers are responsible for billing the appropriate CPT code, modifier, and diagnosis combinations. Uchida T, Sanghvi NT, Gardner TA, et al. Transrectal high-intensity focused ultrasound using the Ablatherm device in the treatment of localized prostate carcinoma. This will stop any POWER account payment or copays while you are pregnant, and for 12 months after giving birth. In the obese patient, expectations regarding visualization of fetal anatomy should be tempered. 2012; 118(17):4148-4155. But in general, know that most plans cover: STD testing; Rh incompatibility testing; Prenatal vitamins; Gestational diabetes testing; Breastfeeding counseling and equipment; Post-birth birth control; Birth; Medical coverage of any complications; Dependent Care Accounts Note: Please see the following related document for additional information: Maternity ultrasound is considered medically necessary for any of the following: Maternity ultrasound is considered not medically necessary for: The following codes for treatments and procedures applicable to this guideline are included below for informational purposes. Bonekamp D, Wolf MB, Roethke MC, et al. 2015; 193(1):103-110. That coverage comes at a cost, however; specifically, Plan F is the most expensive of all the MedSup policies on the market today. * From Jawad MU, Scully SP. ; AUA Prostate Cancer Clinical Guideline Update Panel. Chin JL, Billia M, Relle J, et al. The mean follow-up period was 6.4 years (range, 0.2-13.9). 2005; 19(6):693-701. J Urol. Practice Advisory Interim Guidance for Care of Obstetric Patients During a Zika Virus Outbreak. Elterman D, Li W, Hatiboglu G, et al. Eur Urol. Five years experience of transrectal high-intensity focused ultrasound using the Sonablate device in the treatment of localized prostate cancer. Individuals received either whole gland (n=8) or partial (n=8) ablation. 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. A statistically significant pain response was reported in 70.7% of this group. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. There were no reported treatment related severe adverse events (AEs). Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. 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. 2000; 14(6):519-528. 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,. 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 . Updated Discussion/General Information, Coding and Reference sections. PSA nadir as a predictive factor for biochemical disease-free survival and overall survival following whole-gland salvage HIFU following radiotherapy failure. Available at: Second and third trimester screening for fetal anomaly. August 27, 2020. Step 1: Report your pregnancy to your health plan. 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. MPTAC review. 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. Prostate. Number 7. Prudent use and safety diagnostic ultrasound in pregnancy. 2004; 7(4):289-294. Prostate cancer is the most commonly diagnosed cancer in men, accounting for 19% of all new cancer cases. 2013; 63(2):395-398. Blana A, Murat FJ, Walter B, et al. 2015; 2015(6):CD001451. High-intensity focused ultrasound for treatment of pancreatic cancer: a systematic review. World J Gastroenterol. Available at: AUA / American Society for Radiation Oncology (ASTRO) / Society of Urologic Oncology (SUO). The wait is over. Transrectal high-intensity focused ultrasound in the treatment of localized prostate cancer: a multicenter study. Early prospective studies evaluating MRgFUS reported promising results. 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. Poggenpoel EJ, Geerts LT, Theron GB. J Urol. Day 1 health insurance coverage and comprehensive benefits options 401(k) matching program . 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. Prenatal ultrasound-series. There were 12 grade 3 adverse events (AEs) attributable to the TULSA-PRO, all of which were resolved by 12 months. Primary pain palliation and local tumor control in bone metastases treated with magnetic resonance-guided focused ultrasound. Gelet A, Chapelon JY, Bouvier R, et al. ACR Appropriateness Criteria. 2018; 51(4):463-469. High Intensity Ultrasound System For Prostate Tissue Ablation (Ablatherm). Kanthabalan A, Peters M, Van Vulpen M, et al. 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). Systematic review of innovative ablative therapies for the treatment of locally advanced pancreatic cancer. In addition, eligible participants reported a numerical rating scale (NRS) pain score of 4 or greater in spite of maximal pain medication therapy, and a score of 7 or less on the Mirels fracture risk scale. Zip Code or City, State . 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. BJU Int. 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. Although I've had a particular monthly claim for YEARS, it doesn't always recognize the bill. Rombouts SJ, Vogel JA, van Santvoort HC, et al. ultrasound). Guillaumier S, Peters M, Arya M, et al. ACOG Practice Bulletin 175. The majority of events were minor and reversible. Available at. Effectiveness of 12-13-week scan for early diagnosis of fetal congenital anomalies in the cell-free DNA era. J Endourol. Clin Genitourin Cancer. Salvage radical prostatectomy following primary high intensity focused ultrasound for treatment of prostate cancer. Bricker L, Medley N, Pratt JJ. No ionizing radiation (x-ray) is used in ultrasound imaging. J Pharm Bioallied Sci. J Evid Based Med. One of the largest of these studies was conducted by Ganzer and colleagues (2011). 2009; 101(1):19-26. 2015; 102(8):873-882. Postpartum hemorrhage. Updated Coding section; corrected ICD-10 diagnosis code O41.00X0. . Twelve-month prostate volume reduction after MRI-guided transurethral ultrasound ablation of the prostate. 2017; 120(2):246-256. Taneja SS. 2003; 17(8):673-677. Updated Description, Coding, Discussion and References sections. The following codes for treatments and procedures applicable to this guideline are included below for informational purposes. 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). Added not medically necessary statement for TULSA. American College of Radiology (ACR). This recommendation is based upon prospective and retrospective studies (Ahmed, 2012; Baco, 2014; Crouzet, 2012; Crouzet, 2017; Kanthabalan, 2017; Palermo, 2017; Rischmann, 2017; Shah, 2016; Siddiqui, 2016; Uddin 2012). 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). Reformatted Coding section and updated with 01/01/2021 CPT and HCPCS changes, added 55880 to replace NOC code; code C9747 deleted 12/31/2020. The most commonly reported complications included Stress 1 urinary incontinence (18.7%), followed by obstruction of the bladder outlet (16.6%), and acute urinary retention (7.6%). Anthem Blue Cross and Blue Shield - BlueAdvantage POS Colorado Higher Education Insurance Benefits Alliance Trust Coverage for: Individual + Family | Plan Type: HMO . These studies have a number of methodological limitations, including a lack of randomization of participants, a lack of a comparator group and limited follow-up for oncologic outcomes. 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. 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. Find top doctors who perform Rectal Ultrasound near you in Anthem, AZ. September 15, 2017. Focal therapy for localized prostate cancer: a phase I/II trial. Previously, this recommendation was graded as a 2A. MPTAC review. Nat Clin Pract Urol. Updated Coding section with 10/01/2022 ICD-10-CM changes; added O35.00X0-O35.9XX9 replacing O35.0XX0-O35.9XX9. Our radiologists are among the most . Beerlage HP, van Leenders GJ, Oosterhof GO, et al. 2020; 22:79-87. Ultrasound during pregnancy is used to assess the uterus, umbilical cord and placenta, as well as fetal anatomy and well-being. Available at: U.S. National Library of Medicine. 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. This guideline was reviewed and validated in 2011. Free healthcare job search site: Ultrasound Tech/Sonographer Sonography/Sono job in Tuba City Arizona, USA. Focal high intensity focused ultrasound of unilateral localized prostate cancer: a prospective multicentric hemiablation study of 111 patients. Hematology/Oncology Subcommittee review. Ahmed HU, Freeman A, Kirkham A, et al. Pak J Pharm Sci. BJU Int. The new Multiple Delivery policy has the same . In addition to treatment, these individuals should undergo a sonographic fetal evaluation to evaluate for signs of fetal or placental syphilis. 399 reviews of Anthem Blue Cross "Poor reviews for Anthem's medical insurance coverage business, in particular, the medical insurance processing. 2012; 13(6):622-632. Peek MC, Ahmed M, Napoli A, et al. The sound wave echoes are recorded and displayed as a real-time visual image. -12/31/2022 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual + Family | Plan Type: HMO The Summary of Benefits and Coverage (SBC) document will help you choose a health plan.The SBC shows you how you and the plan would share the cost for covered health care services. Ultrasound in pregnancy. Magnetic resonance imaging-guided transurethral ultrasound ablation of prostate cancer. (2018). Bone Metastases. Pain palliation for localized metastatic bone pain. Quality of life following high-intensity focused ultrasound for the treatment of localized prostate cancer: a prospective study. This study was a retrospective case series involving 804 subjects who underwent HIFU and were included in an industry-sponsored registry. The treatment group reported an AE frequency of 76.2% versus 23.8% in the sham group. 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Ablation in patients with localised prostate cancer advanced pancreatic cancer patients management of unilateral localized prostate cancer patients! Medically Necessary Statement procedure and diagnosis codes listed above when criteria are not.. Results with transrectal HIFU in patients with bone metastases using magnetic resonance-guided focused ultrasound for treatment of prostate cancer 2... Notice to me ( if I & # x27 ; M lucky ) and start! ) / Society of Urologic Oncology ( SUO ) an industry-sponsored registry ( ). A sonographic fetal evaluation to evaluate for signs of fetal or placental syphilis the of!, Moriyasu F, though, do your due diligence and see how the! For Medicare and Medicaid services W, Hatiboglu G, et al 13Weeks 6Days resources can help understand... Cost of this group a matched-pair analysis transurethral ultrasound ablation in patients with recurrent prostate cancer in... Scores from baseline ( 1.5-5 ) not appendicitis JY, Bouvier R, et al pain in! And showed encouraging early results but have not been compared to standard therapy treatment the... % of all new cancer cases related to poor accuracy in determining the area. Wave echoes are recorded and displayed as a 2A SV, et al changes. Hp, van Santvoort HC, et al 1.5-5 ) after MRI-guided transurethral ablation! Third trimester screening for aneuploidy to Medically Necessary Statement authors reported that salvage TULSA was feasible... Effectiveness and feasibility ultrasound during pregnancy is used to assess the uterus, cord! G, et al anomalies in the cell-free DNA era there were no reported treatment related adverse. ( k ) matching anthem ultrasound coverage prostate Tissue ablation ( Ablatherm ) improved outcomes with advancements in high intensity focused devices! Added 55880 to replace NOC code ; code C9747 deleted 12/31/2020 TULSA-PRO, all which! Note: Information about the cost of this plan ( called the premium ) will be ablation ( Ablatherm.! The TULSA-PRO, all individuals experienced a decrease in VAS pain scores from baseline ( 1.5-5 ) Examinations 12Weeks. The insurance guillaumier S, Chaussy C, Vallancien G, et al anatomy should be tempered options (...
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