Available at: High Intensity Ultrasound System For Prostate Tissue Ablation (Focal One). 2012; 118(12):3071-3078. Anttinen and associates (2020) evaluated TULSA use as a partial salvage therapy in individuals with localized, recurrent prostate cancer. In brief: classifications in brief: Mirels' classification: metastatic disease in long bones and impending pathologic fracture. This will stop any POWER account payment or copays while you are pregnant, and for 12 months after giving birth. The document header wording updated from Current Effective Date to Publish Date. Updated Discussion/General Information, References and Websites for Additional Information sections. 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. J Endourol. 2011; 185(4):1246-1254. HIP Maternity will cover enhanced benefits . Geiger D, Napoli A, Conchiglia A, et al. 2015; 56(2):503-509. MPTAC review. BJU Int. 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). Alternatively, the reduced tumor mass caused by thermal ablation may have an analgesic effect. Ultrasound in pregnancy. Updated Discussion/General Information and Reference sections. Magnetic resonance-guided focused ultrasound for patients with painful bone metastases: phase III trial results. First trimester ultrasound tests alone or in combination with first trimester serum tests for Down's syndrome screening. J Ultrasound Med. Bricker L, Medley N, Pratt JJ. The routine use of pulsed Doppler ultrasound to either document or listen to embryonic/fetal cardiac activity is discouraged. Pickles T, Goldenberg L, Steinhoff G. Technology review: high-intensity focused ultrasound for prostate cancer. Safety trial of high-intensity focused ultrasound therapy for pancreatic 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. Prostate Cancer (V1.2023). Transrectal high-intensity focused ultrasound in the treatment of localized prostate cancer. Find a doctor near you. Last Reviewed: August 25, 2022. Participants included those who could not undergo or refused all other available options for pain palliation. Anthem has begun denying coverage for . 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. ACOG Practice Bulletin Number 171. Available at: Centers for Disease Control and Prevention (CDC): How is Prostate Cancer Treated? 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. Updated Description, Discussion and References sections. Siddiqui KM, Billia M, Arifin A, et al. 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. ; AUA Prostate Cancer Clinical Guideline Update Panel. Federal and State law, as well as contract language, and Medical Policy take precedence over Clinical UM Guidelines. Medicare Supplement Plan F is great because it provides the most coverage of the 10 currently available MedSup plans. J Bone Joint Surg Am. Step 2: After you become pregnant, you will join HIP Maternity. In 2015, The U.S. Food and Drug Administration (FDA) approved two devices for use in prostate cancer. Pregnant Women. The current evidence is insufficient to support the use of HIFU as a generally accepted oncological treatment. Cancer. Dupr A, Melodelima D, Prol D, et al. 2014; 96(9):743-751. Available at: U.S. National Library of Medicine. Updated Coding section with 10/01/2018 ICD-10-CM diagnosis code changes; added Q51.20-Q51.28, Z20.821. 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. 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. 2021; 127(5):544-552. MPTAC review. J Urol. HIFU therapy was included in a comparative effectiveness review of clinically localized prostate cancer treatments (Dahm, 2020). Indiana Medicaid provides coverage to pregnant women through two programs. MPTAC review. Updated Discussion, References and Websites for Additional Information sections. An obstetrical ultrasound in the second or third trimester includes an evaluation of fetal number, cardiac activity, presentation, amniotic fluid volume, placental position, fetal biometry, and an anatomic survey. Kenkhuis MJA, Bakker M, Bardi F, ET AL. The TULSA-PRO (Profound Medical Corp., Fort Myers, FL) received 510(k) clearance by the FDA in 2019. 2012; 13(6):622-632. October 2016. Temperatures within the targeted area increase to 60-95C, which destroys the targeted tissue without damaging the adjacent tissue. TULSA is delivered by a system which includes real-time MR thermometry as well as robotically-driven directional thermal ultrasound in a closed loop system to ablate whole gland or targeted areas of the prostate. Chaussy C, Thuroff S. Results and side effects of high-intensity focused ultrasound in localized prostate cancer. The doctors in the emergency room did multiple tests including a CT scan and ultrasound. 2008; 53(6):1194-1201. MPTAC review. Providers are responsible for billing the appropriate CPT code, modifier, and diagnosis combinations. Effectiveness of 12-13-week scan for early diagnosis of fetal congenital anomalies in the cell-free DNA era. Ultrasound Obstet Gynecol. Magnetic resonance imaging-guided transurethral ultrasound ablation of prostate tissue in patients with localized prostate cancer: a prospective Phase 1 clinical trial. Palliative treatment: Treatment given for relief of symptoms and pain rather than attempting to cure. 2014; 11(6):303. Reviewed and validity confirmed 2011. Ultrasound is currently being used as a therapeutic treatment, for example, lithotripsy to disintegrate kidney stones. Recommendations for the management of a pregnant individuals with suspected Zika virus infection include: The 2021 CDC guideline on the treatment of sexually transmitted infections includes management recommendations for individuals who are diagnosed with text in the second half of pregnancy. Transrectal high-intensity focused ultrasound using the Ablatherm device in the treatment of localized prostate carcinoma. Anthem last week said it has updated its coverage policies for ED visits, following criticism of the insurer's policy to deny coverage of ED visits for minor conditions that could "safely [be] treated in less acute facilities." Learn more: Get the primers for reducing avoidable ED utilization Background Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. Salvage magnetic resonance imaging-guided transurethral ultrasound ablation for localized radiorecurrent prostate cancer: 12-month functional and oncological results. 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). Ultrasound imaging can be used after delivery to evaluate abnormalities of the reproductive and adjacent structures. Ahhhhh! Pain palliation for localized metastatic bone pain Bone pain is a common complaint for individuals with metastatic cancer to the bone. 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). Blana A, Murat FJ, Walter B, et al. 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. Insurance coverage for whole-breast ultrasound is evolving. Updated: June 16, 2022. Updated Coding section with 10/01/2016 ICD-10-CM diagnosis code changes. Location: Tuba City<br>We currently have a client in Tuba City, AZ looking for a Licensed Ultrasound Technologist!<br><br>Focus Staff is seeking a traveling Licensed Ultrasound Technologist to perform ultrasound procedures on ambulatory and hospital patients in a physician office, clinic, and hospital setting as requested by a physician or other licensed provider for the diagnosis of disease . As of January 10, 2022, through January 31, 2022, Anthem and its delegated entities will suspend select prior authorization requirements to allow healthcare providers to focus on caring for patients diagnosed with COVID-19. J Natl Cancer Inst. Updated Coding section with additional diagnosis codes D25.0-D25.9, O26.872-O26.879, O99.210-O99.213, O99.810. Researchers used the visual analog pain score (VAS) to measure pain levels. Invest Radiol. Liberman B, Gianfelice D, Inbar Y, et al. Available at: U.S. National Library of Medicine. Find top doctors who perform Rectal Ultrasound near you in Anthem, AZ. 2009; 101(1):19-26. Practice Advisory Interim Guidance for Care of Obstetric Patients During a Zika Virus Outbreak. Prostate cancer therapy with high-intensity focused ultrasound. Crouzet S, Chapelon JY, Rouvire O, et al. Eur Urol. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia . ACOG Practice Bulletin Number 229. 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 . The uterus, cervix, adnexa, and cul-de-sac region should be examined. The authors noted that incomplete tumor ablation could be related to poor accuracy in determining the target area or movement during the procedure. The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. These adjustments apply to members of Commercial business, including self-insured plans, Medicare, and Medi-Cal business. AIUM Practice Parameter for the Performance of Detailed Second- and Third-Trimester Diagnostic Obstetric Ultrasound Examinations. The SBC shows you how you and the plan would share the cost for covered health care services. The guideline addresses several non-extirpative therapies and concluded that these therapies, including HIFU, are investigational for the treatment of renal masses. Br J Surg. Whole-gland salvage high-intensity focused ultrasound therapy for localized prostate cancer recurrence after external beam radiation therapy. TULSA was developed as an alternative method of prostate tissue ablation. HIFU treatment is combined with a visualization method, frequently MR guidance, to better guide treatment in real time. Assess significant discrepancy between uterine size and dates; Follow-up for observation of identified fetal or cord anomaly; Evaluate suspected fetal growth abnormality (either growth restriction or macrosomia), and to follow proven or suspected intrauterine growth restriction; Confirm suspected or follow confirmed diagnosis of polyhydramnios or oligohydramnios; Estimate fetal weight or presentation in premature rupture of membranes or preterm labor; Serial evaluation of fetal growth in multi-fetal pregnancy. We are now accepting all Anthem Blue Cross Blue Shield patients. Replaced term women with individual within clinical indications. In addition, there are limitations on tissue tolerance at sites previously irradiated. 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. 2016; 47(4):530-532. 1999a; 54(2):273-277. Nat Rev Clin Oncol. That coverage comes at a cost, however; specifically, Plan F is the most expensive of all the MedSup policies on the market today. 2017. In the December 2013 issue of Network Update, you were notified of the following: For claims with dates of service on or after March 17, 2014, Anthem Blue Cross and Blue Shield (Anthem) in Indiana, Kentucky, Missouri, Ohio and Wisconsin (individually referred to herein as the Health Plan), will no longer reimburse CPT code 76942 (Ultrasonic . Updated References. Due to variances in utilization patterns, each plan may choose whether to adopt a particular Clinical UM Guideline. NOTE: Information about the cost of this plan (called the . Updated Discussion/General Information, References and Websites for Additional Information sections. August 15, 2019. Due to variances in utilization patterns, each plan may choose whether to adopt a particular Clinical UM Guideline. The pain severity score was significantly reduced from a baseline mean of 7.1 (Standard Deviation[SD] 2.08) (4-10; 95% confidence interval [CI], 6.07-8.15), to 2.5 (SD 1.4) (0-5; 95% CI, 1.81-3.2) at 1 month. National Coverage Determination: Ultrasound diagnostic procedures. The sound wave echoes are recorded and displayed as a real-time visual image. 2015; 28(3 Suppl):1097-1100. 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 . check_circle Item Saved! Bertrand AS, Iannessi A, Natale R, et al. Shi Y, Ying X, Hu X, et al. Urology. Mirels scoring system: A scoring system based upon lesion characteristics and pain levels used to classify pathologic fracture risk. Number 7. The most relevant clinical information is obtained when serial exams are done at least three weeks apart, beginning no earlier than 18 weeks gestation. 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%). For pregnant women with laboratory evidence of Zika infection, ultrasound to evaluate for fetal abnormalities consistent with congenital Zika virus syndrome is recommended. . 2000; 14(6):519-528. 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. Updated September 20, 2021. 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. Pain severity was further reduced at the 3-month follow-up to 1 (SD 1.1) (0-3; 95% CI, 0-1.85) (p=0.001). Government Agency, Medical Society, and Other Authoritative Publications: Maternal UltrasoundObstetricPrenatalSonography. . Accessed on October 20, 2022. Nair SM, Hatiboglu G, Relle J, et al. A total of 29 individuals underwent a follow-up biopsy, either at 12 months only, or at 12 and 36 months. Revised May 20, 2020. 2014; 65(5):907-914. Updated Description, Discussion, References and Websites for Additional Information sections. Low-Intensity Pulsed Ultrasound for Fracture Nonunion. Five years experience of transrectal high-intensity focused ultrasound using the Sonablate device in the treatment of localized prostate cancer. Available at: Magnetic Resonance guided Focused Ultrasound Surgery System (MRgFUS) ExAblate Model 2000/2100. Focal therapy for localised unifocal and multifocal prostate cancer: a prospective development study. 2014; 84(5):1157-1162. On October 9, the FDA granted de novo clearance to SonaCare Medical, LLC (Charlotte, NC) to market the Sonablate 450 for prostate tissue ablation. In 2013, Napoli and colleagues treated 18 individuals with painful bone metastases with MRgFUS. Ultrasound examinations can be used to assess fetal anatomy, particularly neuroanatomy, and to monitor growth. Indiana Medicaid for Members. 2011; 3(3):329-338. Routine ultrasound in late pregnancy (after 24 weeks' gestation). Taneja SS. You bet! The study also included a crossover component; 17 of the 23 individuals in the placebo group who did not complete follow-up chose to receive rescue MRgFUS after a lack of response to placebo. Updated Description, Discussion, References and Websites for Additional Information sections. 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 Cochrane Database Syst Rev. Technology insight: High-intensity focused ultrasound for urologic cancers. Eur Urol. High intensity focused ultrasound (HIFU): A surgical procedure that uses focused high energy sound waves to destroy target tissues in the body. 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. 2005; 4(3):187-192. 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 . Gelet A, Chapelon JY, Bouvier R, et al. Jpn J Clin Oncol. High Intensity Ultrasound System For Prostate Tissue Ablation (Ablatherm). Similar to prostate cancer, there is a lack of randomized trials comparing HIFU to standard treatment options. MRI-TULSA resulted in an 88% reduction of viable prostate tissue volume. 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. There are concerns about inconsistent treatment coverage within renal masses resulting in incomplete ablation. Clin Orthop Relat Res. The majority of attributable AEs were grade 1 or 2. The remaining 11.1% (2/18) reported pain reoccurrence which required pharmacological care. December 2016. . Hematology/Oncology Subcommittee review. There were no new reported serious AEs. This document addresses the use of maternity ultrasound in the outpatient setting. 2005; 2(4):191-198. 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. $0 virtual care, 24/7. Peek and associates (2015) conducted a systematic review of the use of HIFU in breast cancer. 2010; 468(10):2825-2827. J Endourol. You should contact Anthem Blue Cross and Blue Shield directly to appeal denial of coverage for medical claims by calling 1855- -641-4862. An mpMRI, a transrectal ultrasound guided biopsy and a cystoscopy were performed at 12 months post-procedure. 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. 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. Eur Radiol. To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the member's card. Eur Urol Open Sci. 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. $15 UK HEALTHCARE PRIMARY CARE CO-PAY $25 ANTHEM PRIMARY CARE CO-PAY $40 Ultrasound, the use of low-intensity sound waves to produce images, is an established diagnostic tool. Initial document development. 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. 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. HIFU was comparable to the median survival in standard chemotherapy. Reformatted Coding section. Reaffirmed 2021. Added not medically necessary statement for TULSA. Br J Surg. An individual with out-of-field recurrence underwent a repeat salvage TULSA. Chin JL, Billia M, Relle J, et al. Available at: Second and Third Trimester Vaginal Bleeding. 2013; 48(6):351-358. 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. 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. American College of Obstetricians and Gynecologists (ACOG). Focused ultrasound for the treatment of bone metastases: effectiveness and feasibility. There were 12 grade 3 adverse events (AEs) attributable to the TULSA-PRO, all of which were resolved by 12 months. Int J Clin Pract. Errico A. 2009; 16(1):140-146. High-intensity focused ultrasound for the treatment of localized prostate cancer: 5-year experience. 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. Cochrane Database Syst Rev. In an intent-to-treat analysis, 63% (72/115) were reported to have a complete histological response and had no evidence of cancer. The 2018 American Urological Association/American Society for Radiation Oncology/Society of Urologic Oncology (AUA/ASCO/SUO) notes that high intensity focused ultrasound treatment is not a standard care option for low, intermediate or high risk or localized prostate cancer.
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