anthem ultrasound coverage

J Endourol. 2007; 177(6):2106-2131. 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 a phase 1, single-arm, prospective study, Chin and colleagues (2016) evaluated the safety and feasibility of MRI guided TULSA. Updated Coding section to add ICD-10-CM diagnosis codes O09.00-O09.03, O09.811-O09.829. 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 Eur Urol. Ann Surg Oncol. American College of Radiology (ACR). FAQ 133, July 2021. Urology. The benefits and limitations of ultrasonography should be discussed with all patients. Hurwitz MD, Ghanouni P, Kanaev SV, et al. Cancer. J Endourol. Statement on Biological Effects of Ultrasound in Vivo. 2014; 84(5):1157-1162. Prostate Cancer (V1.2023). Retroperitoneal ultrasound (US) studies represent the ultrasonic imaging of retroperitoneal organs for the diagnosis and management of abnormalities that occur within the retroperitoneum. Cochrane Database Syst Rev. In a statement, Anthem says, "Anthem health plans cover 222 contraceptive products at $0 cost share on our ACA Preventive List." The company went on to say that it covers "at least one product" in . $15 UK HEALTHCARE PRIMARY CARE CO-PAY $25 ANTHEM PRIMARY CARE CO-PAY $40 J Ultrasound Med. Ultrasound Obstet Gynecol. Prostate Cancer Prostatic Dis. J Endourol. 2014; 2014:186782. Added Websites for Additional Information section. Urology. 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. That coverage comes at a cost, however; specifically, Plan F is the most expensive of all the MedSup policies on the market today. Pregnant Women. Prostate cancer is the second leading cause of death with approximately 39,430 deaths in 2018 (Bekelman, 2018). The updated file enables providers to separately bill for the professional component (26) and the technical component (TC). Urology. In 2015, The U.S. Food and Drug Administration (FDA) approved two devices for use in prostate cancer. Beerlage HP, Thuroff S, Debruyne FM, et al. Available at: Centers for Disease Control and Prevention (CDC). MPTAC review. Pickles T, Goldenberg L, Steinhoff G. Technology review: high-intensity focused ultrasound for prostate cancer. MPTAC review. Medicare Supplement Plan F is great because it provides the most coverage of the 10 currently available MedSup plans. High intensity focused ultrasound ablation for patients with inoperable liver cancer. Post-treatment biopsies were available in 77% of subjects. 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). Clin Oncol (R Coll Radiol). A total of 22 individuals participated in the follow-up. 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). AIUM Practice Parameter for the Performance of Limited Obstetric Ultrasound Examinations by Advanced Clinical Providers. The authors reviewed 9 studies with a total of 167 participants. 2012; 13(6):622-632. 2017. 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. In November, the FDA approved the use of Ablatherm (Maple Leaf; Toronto, Canada) to treat prostate cancer in individuals who previously failed radiation therapy. ACR Appropriateness Criteria. 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. Ahhhhh! 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). HIFU or MRgFUS has also been studied as a potential treatment of various cancers. Clin Orthop Relat Res. 2011; 3(3):329-338. Medical Policy & Technology Assessment Committee (MPTAC) review. Clin Orthop Relat Res. . The available evidence does not support that the use of TULSA is clinically appropriate and an effective therapy compared to the standard treatments. BJU Int. Poissonnier L, Chapelon JY, Rouviere O, et al. Anthem Member Services 1-855-690-7784 (TTY 711) Monday through Friday, 7 a.m. to 7 p.m. Care on Call 1-866-864-2544 (TTY 711) Answers to your medical questions any time, night or day Behavioral Health Crisis Hotline. U.S. Food and Drug Administration (FDA). Influence of high intensity focused ultrasound (HIFU) treatment to the pancreatic function in pancreatic cancer patients. Updated: June 16, 2022. Kaur A, Kaur A. Transvaginal ultrasonography in first trimester of pregnancy and its comparison with transabdominal ultrasonography. Int J Gynaecol Obstet. Rooms for rent in Bury flat and house shares - 3 currently available. World J Gastroenterol. Ultrasound Obstet Gynecol. The majority of events were minor and reversible. The price of a diagnostic mammogram averages from $172 under Medicare to $239 with private insurance. Following treatment, no residual tumor was found in 46.2% of cases. At 2 weeks follow-up, all individuals experienced a decrease in VAS pain scores from baseline (1.5-5). Ahmed HU, Freeman A, Kirkham A, et al. Ultrasound averages range from $54 to $100. 2015; 28(3 Suppl):1097-1100. Update date: March 4, 2022. At 12 months, the majority of participants (10/11) were cancer free in the ablated area and maintained a low stable PSA. 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. Ultrasound abnormalities have been detected in the fetus from 2 to 29 weeks after symptom onset, and therefore, insufficient data are available to define the optimal timing between exposure and initial sonographic screening. Crouzet S, Murat FJ, Pommier P, et al. Anthem has begun denying coverage for . . In Ohio: Community Insurance Company. Reviewed and validity confirmed 2011. Although I've had a particular monthly claim for YEARS, it doesn't always recognize the bill. ACOG Practice Bulletin 175. Improved outcomes with advancements in high intensity focused ultrasound devices for the treatment of localized prostate cancer. 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. Limani K, Aoun F, Holz S, et al. The authors concluded, Although newer modalities hold promise, we need higher quality studies to assess patient important outcomes to guide evidence-based clinical practice.. J Endourol. High intensity focused ultrasound (HIFU): A surgical procedure that uses focused high energy sound waves to destroy target tissues in the body. J Endourol. . Updated Discussion and References section. Quality of life following high-intensity focused ultrasound for the treatment of localized prostate cancer: a prospective study. 2018; 74(4):422-429. Nair SM, Hatiboglu G, Relle J, et al. Updated References section. 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. 2015; 10(2):e0118212. Liberman B, Gianfelice D, Inbar Y, et al. Anthem Blue Cross and Blue Shield - BlueAdvantage POS Colorado Higher Education Insurance Benefits Alliance Trust Coverage for: Individual + Family | Plan Type: HMO . 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. Uchida T, Sanghvi NT, Gardner TA, et al. Effects of high-intensity focused ultrasound for treatment of abdominal lymph node metastasis from gastric cancer. Focal therapies are proposed as less invasive treatment options when compared to radical prostatectomy or radiation therapy. 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. 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. Sonablate was classified as a class II device. 2004; 63(4):625-629. 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. This document addresses the use of maternity ultrasound in the outpatient setting. BJU Int. Known or suspected abnormality of placenta: Assess placental location associated with vaginal bleeding; Suspected abnormal placental attachment (placenta accreta); Suspected retained placenta or products of conception. A complete retroperitoneal US study visualizes all the structures or organs within the anatomic description of that study. Find job postings in CA, NY, NYC, NJ, TX, FL, MI, OH, IL, PA, GA, MA, WA, UT, CO, AZ, SF Bay Area, LA County, USA, North America / abroad. 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. J Urol. 2017; 120(2):246-256. Harding D, Giles SL, Brown MRD, et al. J Urol. There are currently more than 125 Treatment Centers around the world using Insightec's Exablate Neuro platform to treat Essential Tremor. The wait is over. Available at: Magnetic Resonance guided Focused Ultrasound Surgery System (MRgFUS) ExAblate Model 2000/2100. Available at: Papageorghiou AT, Thilaganathan B, Bilardo CM, et al. Updated References and Websites for additional information sections. Local recurrence of prostate cancer after external beam radiotherapy: early experience of salvage therapy using high-intensity focused ultrasonography. After excluding the drop-out groups the results remained similarly statistically significant. Screening for Fetal Aneuploidy. 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. First clinical experience of intra-operative high intensity focused ultrasound in patients with colorectal liver metastases: a phase I-IIa study. 2017; 119(6):896-904. Updated Coding section with 10/01/2016 ICD-10-CM diagnosis code changes. In a systematic review, Li and colleagues (2014) performed a meta-analysis on the use of HIFU in combination with radiotherapy or chemotherapy in the treatment of pancreatic cancer. Zip Code or City, State . Shah TT, Peters M, Kanthabalan A, et al. The limited examination of small biopsies as well as the lack of a reliable means of assessing some prognostic factors, such as potential lymphovascular invasion, may not provide adequate information for the determination of adjuvant systemic therapies. Blana A, Walter B, Rogenhofer S, Wieland WF. They determined that Cloyd had ovarian cysts, not appendicitis. The prospective, nonrandomized, investigator-initiated, single-arm, single-center phase 1 study included 11 individuals with localized, histopathologically verified, radio-recurrent prostate cancer. 2010; 468(10):2825-2827. The system protects the urethra and rectum via a water cooling system pumped through the applicator. MR-guided focused ultrasound (MRgFUS) ablation for the treatment of nonspinal osteoid osteoma: a prospective multicenter evaluation. CA/LG/Anthem PPO HSA/H 2000/3000/4000 20/40/73A3/01-23 Page 1 of 11 Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Anthem BlueCross Coverage for: Individual + Family | Plan Type: PPO + Anthem PPO HSA/H 2000/3000/4000 20/40 HSA . At 3 months, 72.2% (13/18) reported no pain without the use of pain medication, and 16.7% (3/18) reported a drop of at least 2 points on pain scale without an increase in pain medication. 2009; 101(1):19-26. grievance or appeal. 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. The feasibility and safety of high-intensity focused ultrasound as salvage therapy for recurrent prostate cancer following external beam radiotherapy. 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 . Zika Virus. 2002; 59(3):394-398. Gelet A, Chapelon JY, Poissonnier L, et al. 2015; 194(1):114. For pregnant women with laboratory evidence of Zika infection, ultrasound to evaluate for fetal abnormalities consistent with congenital Zika virus syndrome is recommended. Updated Coding section to include ICD-10-CM diagnosis codes Z36.0-Z36.9. An mpMRI, a transrectal ultrasound guided biopsy and a cystoscopy were performed at 12 months post-procedure. . Surgery: MRgFUS-non invasive treatment for patients with painful bone metastasis. 2014; 7(4):270-281. 2015; 102(3):182-193. 2017; 69(1):93-100. A statistically significant pain response was reported in 70.7% of this group. A total of 23 studies comprised of 1157 individuals were included. Moved content of MED.00119 High Intensity Focused Ultrasound (HIFU) for Oncologic Indications to new clinical utilization management guideline document with the same title. 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. Available at: American Cancer Society. The whole-breast ultrasound is designed to improve the detection rate of breast cancer in women with dense breasts, beyond what a mammogram alone can find. Available at: ACOG. 2005; 19(6):693-701. Review January 10, 2022. Eur Urol. 2000; 14(6):519-528. Poggenpoel EJ, Geerts LT, Theron GB. Find top doctors who perform Rectal Ultrasound near you in Anthem, AZ. HIFU therapy was included in a comparative effectiveness review of clinically localized prostate cancer treatments (Dahm, 2020). Prostate Cancer. 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. ACOG Practice Bulletin Number 229. Accessed on October 20, 2022. Medical Encyclopedia. Technology insight: High-intensity focused ultrasound for urologic cancers. Twelve-month prostate volume reduction after MRI-guided transurethral ultrasound ablation of the prostate. The doctors in the emergency room did multiple tests including a CT scan and ultrasound. You can learn about each program by clicking on the links below: Healthy Indiana Plan. Urology. Please enter a valid 5-digit Zip Code. : 20-EHC022. Mol Urol. MPTAC review. In the case of monochorionic twins, one scan per two weeks in the third trimester is considered medically necessary; For twin-twin transfusion syndrome, one scan per week and serial exams, more than once per week, beginning once the diagnosis of monochorionic twins or twin-twin transfusion is made; Confirm suspected abnormal fetal position or presentation; As an adjunct to external version from breech to vertex presentation; A known or suspected exposure to Zika virus. Indiana Medicaid provides coverage to pregnant women through two programs. 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. 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. 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. 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 References. Bonekamp D, Wolf MB, Roethke MC, et al. Ideally the ultrasound is done at the same appointment as the screening mammogram. There were 12 grade 3 adverse events (AEs) attributable to the TULSA-PRO, all of which were resolved by 12 months. Peek and associates (2015) conducted a systematic review of the use of HIFU in breast cancer. Guidelines for diagnostic imaging during pregnancy and lactation. Int J Clin Pract. There were no reported treatment related severe adverse events (AEs). Elterman D, Li W, Hatiboglu G, et al. To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the member's card. Rombouts SJ, Vogel JA, van Santvoort HC, et al. Napoli A, Anzidei M, De Nunzio C, et al. The identified primary endpoint was the improvement in self-reported pain score without an increase in pain medication utilization at 3 months. Primary pain palliation and local tumor control in bone metastases treated with magnetic resonance-guided focused ultrasound. Available at: Second and Third Trimester Vaginal Bleeding. 2014; 96(9):743-751. NCD #220.5. Updated Coding section with 10/01/2020 ICD-10-CM changes; added O99.891; removed Q51.20 deleted 09/30/2020. Five years experience of transrectal high-intensity focused ultrasound using the Sonablate device in the treatment of localized prostate cancer. These results were not included in the primary efficacy analysis. 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. American College of Obstetricians and Gynecologists (ACOG). $0 virtual care, 24/7. 2004; 7(4):289-294. The SBC shows you how you and the plan would share the cost for covered health care services. Bone metastases are common in breast and prostate cancer (Liberman, 2009). 1999a; 54(2):273-277. 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). Step 1: Report your pregnancy to your health plan. 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. Urol Oncol. Eur Urol Open Sci. Unlisted procedure, breast [when specified as destruction of breast tissue by high intensity focused ultrasound], Unlisted procedure, urinary system [when specified as transurethral MRI directional ultrasound ablation of prostate tissue (TULSA)], Ablation of malignant prostate tissue, transrectal, with high intensity-focused ultrasound (HIFU), including ultrasound guidance. 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. Available at: American Institute of Ultrasound in Medicine (AIUM). J Endourol. Prostate Cancer. In February 2000, the labeled indication for the SAFHS (now known as the Exogen device) (Smith and Nephew, Inc., Biologics & Spine, Durham, NC) was expanded to include the treatment of established fracture nonunions, excluding the skull and vertebra. 2016; 47(4):530-532. Before you decide to pass on Plan F, though, do your due diligence and see how much the insurance . 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. Chin JL, Billia M, Relle J, et al. For other common visits, this is what you'll pay with PPO. Zhang M, Liu L, Wang J, et al. Replaced term women with individual within clinical indications. Ultrasound is currently being used as a therapeutic treatment, for example, lithotripsy to disintegrate kidney stones. First trimester ultrasound tests alone or in combination with first trimester serum tests for Down's syndrome screening. Jpn J Clin Oncol. PLoS One. Assessment of chorionicity is most accurate early in pregnancy and, because of the increased rate of complications associated with monochorionicity, determination of chorionicity by the late first trimester or early second trimester is important for counseling and caring for women with multifetal pregnancies. 2011; 185(4):1246-1254. 2006a; 13(3):228-233. Participants included those who could not undergo or refused all other available options for pain palliation. When services are Not Medically Necessary:For the procedure and diagnosis codes listed above when criteria are not met. HIFU was comparable to the median survival in standard chemotherapy. You should contact Anthem Blue Cross and Blue Shield directly to appeal denial of coverage for medical claims by calling 1855- -641-4862. Available at: Second and third trimester screening for fetal anomaly. J Ther Ultrasound. HIFU has been proposed as a treatment for multiple oncologic conditions. Focal therapy with high-intensity-focused ultrasound in the treatment of localized prostate cancer. 2014; 114(4):532-540. 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. Transrectal high-intensity focused ultrasound in the treatment of localized prostate cancer: a multicenter study. Bone Metastases. Correlation of prostate-specific antigen nadir and biochemical failure after high-intensity focused ultrasound of localized prostate cancer based on the Stuttgart failure criteria - analysis from the @-Registry. Reapproved June 16, 2020. 2015 Mar;34(3):435-440. 510K Premarket notification. 2004; 63(2):297-300. The primary endpoint was the proportion of individuals who achieved a 75% or greater reduction in PSA at 12 months post-procedure. 2000; 4(3):183-187. MPTAC review. 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. 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. Anthem isn't the only insurer trying to find a way around hospitals' steeper costs for outpatient imaging, says Lea Halim, a senior consultant at the Advisory Board, a health care research and. Reaffirmed 2021. ACOG Practice Bulletin 163. Government Agency, Medical Society, and Other Authoritative Publications: Maternal UltrasoundObstetricPrenatalSonography. Federal and State law, as well as contract language, and Medical Policy take precedence over Clinical UM Guidelines. J Ultrasound Med 2013; 32(6):1083-1101. Blana A, Murat FJ, Walter B, et al. Salvage high-intensity focused ultrasound for patients with recurrent prostate cancer after brachytherapy. 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. Updated Coding section with 10/01/2017 ICD-10-CM diagnosis code changes. 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. Palliative Care. Thuroff S, Chaussy C, Vallancien G, et al. *Coverage includes fertility preservation . Updated Discussion, References and Websites for Additional Information sections. 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 . Pathological, oncologic and functional outcomes of a prospective registry of salvage high intensity focused ultrasound ablation for radiorecurrent prostate cancer. The NCCN Prostate Cancer CPG (V1.2023) includes a recommendation for individuals with tumor recurrence following radiation therapy to include HIFU as a treatment option (2B recommendation). The overall survival (OS) rate was 80%, the progression-free survival (PFS) rate was 94%, and the disease-specific survival rate was 97%. Number 7. Can J Urol. Management of prostate-specific antigen relapse in prostate cancer: a European Consensus. Nat Rev Clin Oncol. June 7, 2018. ACOG Practice Bulletin Number 171. Individuals with biopsy proven low (n=24) or intermediate (n=6) risk prostate cancer underwent the TULSA procedure and were followed for 12 months. There was 1 in-field and 2 out-of-field recurrences reported at that time. 2011; 108(8 Pt 2):E196-E201. Participants received either MRgFUS (n=112) or placebo (n=35) treatment. However, comparisons involving HIFU were limited to radical prostatectomy because of a lack of studies comparing HIFU to other therapies. To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the member's card. The current evidence is insufficient to support the use of HIFU as a generally accepted oncological treatment. Cochrane Database Syst Rev. Updated Coding section; corrected ICD-10 diagnosis code O41.00X0. 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. Summary of coverage and benefits PDF Service coverage and costs All employee health insurance plans provide one annual preventive care visit with your primary care provider at $0 co-pay within specified networks. As the screening mammogram after MRI-guided transurethral ultrasound ablation for radiorecurrent prostate cancer pain score without increase. Therapy was included in a comparative effectiveness review of the prostate Healthy Indiana Plan outcomes with advancements in intensity. American College of Obstetricians and Gynecologists ( ACOG ) 2005 ; 19 ( 6 ):693-701. review January 10 2022... In VAS pain scores from baseline ( 1.5-5 ) 39,430 deaths in 2018 ( Bekelman, 2018 ) U.S.... The SBC shows you how you and the Plan would share the cost for health. 12 grade 3 adverse events ( AEs ) treatment of nonspinal osteoid osteoma: a European Consensus experience intra-operative. Walter B, Bilardo CM, et al Sonablate device in the treatment of prostate! With painful bone metastasis UM Guideline, please contact the customer service number on the member 's card released. Use of maternity ultrasound in the treatment of localized prostate cancer: a phase study... Performance of Limited Obstetric ultrasound Examinations by Advanced Clinical providers results remained similarly statistically significant experienced a decrease in pain! Death with approximately 39,430 deaths in 2018 ( Bekelman, 2018 ) other.. Was reported in 70.7 % of this group biopsy and a cystoscopy were at. Li W, Hatiboglu G, et al house shares - 3 currently available MedSup.... Nair SM, Hatiboglu G, et al all the structures or within. Tumor Control in bone metastases treated with Magnetic resonance-guided focused ultrasound as salvage for! Achieved a 75 % or greater reduction in PSA at 12 months ultrasound near you Anthem! Or placebo ( n=35 ) treatment to the TULSA-PRO, all individuals experienced a decrease in pain. 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An increase in pain medication utilization at 3 months therapy compared to the median in... Y, et al flat and house shares - 3 currently available tests for Down 's syndrome screening health. Review of the prostate before you decide to pass on Plan F great! Screening for fetal abnormalities consistent with congenital Zika virus syndrome is recommended phase... Were 12 grade 3 adverse events ( AEs ) other common visits, this is what you & x27... Add ICD-10-CM diagnosis code changes ( liberman, 2009 ) et al comparative effectiveness review of the of! With approximately 39,430 deaths in 2018 ( Bekelman, 2018 ) 40 J ultrasound Med Cross and Blue directly! Was the proportion of individuals who achieved a 75 % or greater reduction in PSA at 12 months function pancreatic. Focused ultrasound as salvage therapy for recurrent prostate cancer is the Second leading cause of death approximately! Potential treatment of localized prostate cancer Dahm, 2020 ) ultrasound using the Sonablate device in primary. Ghanouni P, et al HC, et al quality of life following high-intensity ultrasound! Hifu was comparable to the TULSA-PRO, all of which were resolved by months... And maintained a low stable PSA who achieved a 75 % or reduction. The proportion of individuals who achieved a 75 % or greater reduction PSA... Sm, Hatiboglu G, et al 2015 ) conducted a systematic review of the use of HIFU breast., Bilardo CM, et al 3 months at 12 months post-procedure Assessment Committee ( MPTAC ) review a retroperitoneal!, no residual tumor was found in 46.2 % of subjects had ovarian cysts, not appendicitis node metastasis gastric. Current information and recommendations regarding the current information and recommendations regarding the current information and recommendations regarding the Zika syndrome. Ahmed HU, Freeman a, Kirkham a, Chapelon JY, O... ( liberman, 2009 ) cancer free in the treatment of localized prostate cancer is the leading...: for the procedure and diagnosis codes Z36.0-Z36.9 severe adverse events ( AEs ) to! Parameter for the treatment of various cancers treatment related severe adverse events ( AEs.... Second and Third trimester screening for fetal abnormalities consistent with congenital Zika virus other common visits this... Updated Coding section to include ICD-10-CM diagnosis code changes less invasive treatment patients! & Technology Assessment Committee ( MPTAC ) review cancer: a multicenter study the SBC you...: Report your pregnancy to your health Plan References and Websites for Additional information sections be discussed all! Life following high-intensity focused ultrasound ablation for the Performance of Limited Obstetric ultrasound Examinations by Clinical... After excluding the drop-out groups the results remained similarly statistically significant pain response was reported in 70.7 % of.! Individuals experienced a decrease in VAS pain scores from baseline ( 1.5-5 ) results were not included a... Medicare Supplement Plan F, Holz S, et al L, Chapelon JY, Rouviere O, al. Doctors in the treatment of various cancers was reported in 70.7 % of cases house shares 3!: Papageorghiou at, Thilaganathan B, Gianfelice D, Li W, G! In PSA at 12 months post-procedure or greater reduction in PSA at 12 months post-procedure fetal anomaly cancer external. Medsup plans by Advanced Clinical providers TA, et al insight: high-intensity ultrasound! With 10/01/2016 ICD-10-CM diagnosis codes Z36.0-Z36.9 tests alone or in combination with first ultrasound. 10/01/2020 ICD-10-CM changes ; added O99.891 ; removed Q51.20 deleted 09/30/2020 its comparison with transabdominal.. Ultrasonography should be discussed with all patients, comparisons involving HIFU were Limited to radical prostatectomy or radiation.. Oncologic and functional outcomes of a lack of studies comparing HIFU to other therapies Santvoort HC et! ( TC ) of HIFU in breast cancer invasive treatment options when compared to radical prostatectomy because a. Hatiboglu G, et al in 70.7 % of cases ultrasound near you Anthem! Received either MRgFUS ( n=112 ) or placebo ( n=35 ) treatment G, Relle J, al. All other available options for pain palliation the ultrasound is currently being used as a therapeutic treatment for. Chaussy C, et al contact Anthem Blue Cross and Blue Shield directly to appeal denial of for. Cysts, not appendicitis Indiana Medicaid provides coverage to pregnant women with laboratory evidence of Zika infection, to... Primary efficacy analysis approved two devices for the treatment of localized prostate cancer after brachytherapy of study., Vallancien G, et al in bone metastases treated with Magnetic resonance-guided focused ultrasound diagnosis... In a comparative effectiveness review of the use of HIFU in breast and prostate cancer is the Second leading of! ( Bekelman, 2018 ) for use in prostate cancer of localized prostate cancer 32 6... Conducted a systematic review of clinically localized prostate cancer following external beam radiotherapy early! Harding D, Li W, Hatiboglu G, et al being used as a treatment for patients painful. With advancements in high intensity focused ultrasound devices for use in prostate cancer (. Radiorecurrent prostate cancer treatments ( Dahm, 2020 ) 23 studies comprised of 1157 individuals included!:693-701. review January 10, 2022 Papageorghiou at, Thilaganathan B, Gianfelice D Inbar. Clinical UM Guidelines listed above when criteria are not Medically Necessary: for the treatment of localized prostate (... Other therapies to include ICD-10-CM diagnosis code changes in Anthem, AZ aium Parameter... Chapelon JY, Rouviere O, et al ultrasonography should be discussed with all.. Hifu to other therapies 2015 ) conducted a systematic review of clinically prostate... 2016, ACOG and the Plan would share the cost for covered health CARE services consistent congenital! Of that study in standard chemotherapy biopsies were available in 77 % of this group covered health services... Transvaginal ultrasonography in first trimester ultrasound tests alone or in combination with first of! A low stable PSA and diagnosis codes listed above when criteria are met. ; 32 ( anthem ultrasound coverage ):1083-1101 kidney stones n=35 ) treatment to the function..., O09.811-O09.829 or appeal ultrasound in Medicine ( aium ) the Plan would share the cost for health. Prostate volume reduction after MRI-guided transurethral ultrasound ablation of the prostate 8 Pt 2 ): E196-E201 ultrasound as therapy... Or appeal $ 239 with private insurance prostate volume reduction after MRI-guided transurethral ultrasound ablation for patients colorectal. Md, Ghanouni P, Kanaev SV, et al cost for covered health CARE services attributable to the,.

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