Reaffirmed 2021. Palliative treatment: Treatment given for relief of symptoms and pain rather than attempting to cure. The available evidence does not support that the use of TULSA is clinically appropriate and an effective therapy compared to the standard treatments. Evaluate for threatened, incomplete, or missed abortion; Non-reassuring fetal heart rate monitoring; Assess amniotic fluid volume in post-term gestation. Uchida T, Tomonaga T, Kim H, et al. At 12 months, the majority of participants (10/11) were cancer free in the ablated area and maintained a low stable PSA. 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. A total of 22 individuals participated in the follow-up. 2015; 102(3):182-193. 2004; 63(2):297-300. Eur Urol. New reimbursement policy: Maternity Services and Multiple Delivery (Professional) Beginning with dates of service on or after December 1, 2019, Anthem's current Routine Obstetrics policy will be retired and will be replaced by the new Maternity Services policy and the new Multiple Delivery policy. Available at: Antepartum Fetal surveillance. 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. Government Agency, Medical Society, and Other Authoritative Publications: Maternal UltrasoundObstetricPrenatalSonography. $0 plans in select areas. Rebillard X, Gelet A, Davin JL, et al. BJU Int. First clinical experience of intra-operative high intensity focused ultrasound in patients with colorectal liver metastases: a phase I-IIa study. 2005; 51(10):651-658. . Participants included those who could not undergo or refused all other available options for pain palliation. The difference in response rates between MRgFUS and placebo at 3 months was significant (64.3% versus 20.0%). In brief: classifications in brief: Mirels' classification: metastatic disease in long bones and impending pathologic fracture. NOTE: Information about the cost of this plan (called the premium) will be . Prostate cancer is the second leading cause of death with approximately 39,430 deaths in 2018 (Bekelman, 2018). These resources can help members understand their maternity benefits. 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. J Endourol. Kaur A, Kaur A. Transvaginal ultrasonography in first trimester of pregnancy and its comparison with transabdominal ultrasonography. Ahmed HU, Hindley RG, Dickinson L, et al. 2010; 468(10):2825-2827. A complete retroperitoneal US study visualizes all the structures or organs within the anatomic description of that study. ISUOG Interim Guidance on ultrasound for Zika virus infection in pregnancy: information for healthcare professionals. Blana A, Walter B, Rogenhofer S, Wieland WF. J Urol. 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). 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. Salvage radical prostatectomy following primary high intensity focused ultrasound for treatment of prostate cancer. The identified primary endpoint was the improvement in self-reported pain score without an increase in pain medication utilization at 3 months. The SBC shows you how you and the plan would share the cost for covered health care services. 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. Beerlage HP, Thuroff S, Debruyne FM, et al. August 15, 2019. 2001; 15(4):437-440. 15727 Anthem Pkwy, Suite 600 . The current evidence is insufficient to support the use of HIFU as a generally accepted oncological treatment. Ahmed HU, Cathcart P, McCartan N, et al. Comprehensive medical coverage that covers many common services at no cost or for a low copay. Available at: Centers for Disease Control and Prevention (CDC). Coverage varies some from plan to plan, so check your plan's specifics. Focal salvage high-intensity focused ultrasound in radiorecurrent prostate cancer. Schatzl G, Madersbacher S, Djavan B, et al. This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for Ultrasound, Soft Tissues of Head and Neck. 2012; 105(2):198-202. November 6, 2015. 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. 2013; 48(6):351-358. ultrasound). NCCN Clinical Practice Guidelines in Oncology. Insurance coverage for whole-breast ultrasound is evolving. Find a doctor near you. $0 virtual care, 24/7. Rooms for rent in Bury flat and house shares - 3 currently available. Updated Discussion/General Information and Reference sections. 2004; 58(4):382-390. High-intensity focused ultrasound in the treatment of primary prostate cancer: the first UK series. Hinyokika Kiyo. Focal salvage therapy for localized prostate cancer recurrence after external beam radiotherapy: a pilot study. Albisinni S, Aoun F, Bellucci S, et al. Urology. AIUM Practice Parameter for the Performance of Detailed Diagnostic Obstetric Ultrasound Examinations Between 12Weeks 0Days and 13Weeks 6Days. Pregnant Women. Whole-gland ablation of localized prostate cancer with high-intensity focused ultrasound: oncologic outcomes and morbidity in 1002 patients. 2000; 37(6):695-701. Pathological, oncologic and functional outcomes of a prospective registry of salvage high intensity focused ultrasound ablation for radiorecurrent prostate cancer. 2004; 7(4):289-294. Due to variances in utilization patterns, each plan may choose whether to adopt a particular Clinical UM Guideline. The following codes for treatments and procedures applicable to this guideline are included below for informational purposes. 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 . 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 . High intensity focused ultrasound ablation for patients with inoperable liver cancer. The primary endpoint was the proportion of individuals who achieved a 75% or greater reduction in PSA at 12 months post-procedure. Participants were followed for up to 5 years post-procedure. Hoosier Healthwise. 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). One of the largest of these studies was conducted by Ganzer and colleagues (2011). Practice Advisory Interim Guidance for Care of Obstetric Patients During a Zika Virus Outbreak. The five HIFU trials included a total of only 136 individuals. In 2016, ACOG and the SMFM released a practice advisory regarding the current information and recommendations regarding the Zika virus. Muto S, Yoshii T, Saito K, et al. Updated Coding section with 10/01/2016 ICD-10-CM diagnosis code changes. Summary of Safety and Effectiveness Data (SSED). Indiana Medicaid provides coverage to pregnant women through two programs. 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 price of a diagnostic mammogram averages from $172 under Medicare to $239 with private insurance. Researchers used the visual analog pain score (VAS) to measure pain levels. . Alternatively, commercial or FEP plans or lines of business which determine there is not a need to adopt the guideline to review services generally across all providers delivering services to Plans or line of businesss members may instead use the clinical guideline for provider education and/or to review the medical necessity of services for any provider who has been notified that his/her/its claims will be reviewed for medical necessity due to billing practices or claims that are not consistent with other providers, in terms of frequency or in some other manner. 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. Low-Intensity Pulsed Ultrasound for Fracture Nonunion. Pickles T, Goldenberg L, Steinhoff G. Technology review: high-intensity focused ultrasound for prostate cancer. MPTAC review. Peek and associates (2015) conducted a systematic review of the use of HIFU in breast cancer. 2017; 3:CD012600. Elterman D, Li W, Hatiboglu G, et al. Alldred SK, Takwoingi Y, Guo B, et al. Available at: Centers for Medicare and Medicaid Services. 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). Napoli A, Anzidei M, Marincola BC, et al. Transrectal high-intensity focused ultrasound in the treatment of localized prostate cancer: a multicenter study. Reviewed and validity confirmed 2011. CPT Only - American Medical Association, RAD.00038 Use of 3-D, 4-D or 5-D Ultrasound in Maternity Care, https://www.acog.org/-/media/project/acog/acogorg/clinical/files/committee-opinion/articles/2017/10/guidelines-for-diagnostic-imaging-during-pregnancy-and-lactation.pdf, https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2018/12/placenta-accreta-spectrum, https://www.acog.org/clinical/clinical-guidance/practice-bulletin, https://www.smfm.org/publications/220-acog-smfm-joint-practice-advisory-interim-guidance-for-care-of-obstetric-patients-during-a-zika-virus-outbreak, https://www.acr.org/-/media/ACR/Files/Practice-Parameters/US-OB.pdf, https://acsearch.acr.org/docs/69465/Narrative/?_ga=2.211725906.656052169.1601908671-191399006.1564351312, https://acsearch.acr.org/docs/3102400/Narrative/, https://www.aium.org/resources/guidelines/obstetric.pdf, https://www.aium.org/resources/statements.aspx, https://www.aium.org/resources/guidelines.aspx, https://www.cdc.gov/std/treatment-guidelines/STI-Guidelines-2021.pdf, https://www.cdc.gov/zika/hc-providers/types-of-tests.html, https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/ncd103c1_part4.pdf, https://www.acog.org/Patients/FAQs/Routine-Tests-During-Pregnancy, https://www.cdc.gov/ncbddd/birthdefects/diagnosis.html, https://www.cdc.gov/zika/prevention/index.html, https://medlineplus.gov/ency/presentations/100197_1.htm. 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. Hurwitz MD, Ghanouni P, Kanaev SV, et al. Int J Clin Pract. J Urol. Bone Metastases. 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. This document does not address nuchal translucency. MPTAC review. Anttinen M, Mkel P, Viitala A, et al. 2004; 63(4):625-629. ACR-ACOG-AIUM-SMFM-SRU Practice parameter for the performance of obstetrical ultrasound. High-intensity focused ultrasound for the treatment of localized prostate cancer: 5-year experience. Magnetic resonance imaging-guided transurethral ultrasound ablation of prostate tissue in patients with localized prostate cancer: a prospective Phase 1 clinical trial. 2014; 7(4):270-281. 2014; 84(5):1157-1162. AIUM Practice Parameter for the Performance of Limited Obstetric Ultrasound Examinations by Advanced Clinical Providers. 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. Guidelines for diagnostic imaging during pregnancy and lactation. Dupr A, Melodelima D, Prol D, et al. 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. An mpMRI, a transrectal ultrasound guided biopsy and a cystoscopy were performed at 12 months post-procedure. See the following related document for HIFU treatment non-oncologic indications: For information regarding other palliative treatments of metastatic bone lesions, please see the following: Metastatic lesions located 1 centimeter (cm) or greater from skin and major nerve bundles; Individual does not present an increased risk of fracture from the procedure (for example, a score of 7 or less on Mirels fracture risk score); Individual does not require surgical stabilization or have clinically significant comorbidities; Individual is not a candidate for other therapies as evidenced by pain refractory to previous radiation therapy. 399 reviews of Anthem Blue Cross "Poor reviews for Anthem's medical insurance coverage business, in particular, the medical insurance processing. Placenta Accreta Spectrum. Anthem Blue Cross Blue Shield: Health Insurance, Medicare & More Learn more about your coverage options after the Public Health Emergency (PHE) ends. Last Reviewed: August 25, 2022. World J Gastroenterol. Ultrasound Tech in San Antonio, Texas, United States. 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. 2007; 51(2):381-387. This document addresses the use of maternity ultrasound in the outpatient setting. BJU Int. 2017; 119(6):896-904. 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. The document header wording updated from Current Effective Date to Publish Date. Updated Discussion/General Information, References and Websites for Additional Information sections. J Endourol. MPTAC review. You should contact Anthem Blue Cross and Blue Shield directly to appeal denial of coverage for medical claims by calling 1855- -641-4862. Single high intensity focused ultrasound session as a whole gland primary treatment for clinically localized prostate cancer: 10-year outcomes. Evaluation of quality of life outcomes following palliative treatment of bone metastases with magnetic resonance-guided high intensity focused ultrasound: an international multicentre study. Bone metastasis: When cancer cells have broken off from the primary tumor and have settled and started growing on bones. 2018 ) cancer recurrence after external beam radiotherapy: a prospective phase 1 clinical trial liver metastases: prospective! Ablation for patients with localized prostate cancer is the second leading cause of death with approximately 39,430 deaths in (! 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