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First clinical experience of intra-operative high intensity focused ultrasound in patients with colorectal liver metastases: a phase I-IIa study. Reformatted Coding section. Peek MC, Ahmed M, Napoli A, et al. Anthem Blue Cross Blue Shield: Health Insurance, Medicare & More Learn more about your coverage options after the Public Health Emergency (PHE) ends. There's Still Time To Enroll $0 preventive care. Updated September 20, 2021. The identified primary endpoint was the improvement in self-reported pain score without an increase in pain medication utilization at 3 months. Ultrasound examinations can be used to assess fetal anatomy, particularly neuroanatomy, and to monitor growth. Napoli A, Anzidei M, Marincola BC, et al. The SBC shows you how you and the plan would share the cost for covered health care services. Updated Coding section with 10/01/2020 ICD-10-CM changes; added O99.891; removed Q51.20 deleted 09/30/2020. Screening for Fetal Aneuploidy. 2014; 11(6):303. The PSA level, which had dropped following treatment, remained low. Harding D, Giles SL, Brown MRD, et al. Rischmann P, Gelet A, Riche B, et al. Available at: Centers for Disease Control and Prevention (CDC). A multicentre study of 5-year outcomes following focal therapy in treating clinically significant nonmetastatic prostate cancer. Available at: Second and third trimester screening for fetal anomaly. MPTAC review. 2018; 30(4):233-242. -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. Effectiveness of 12-13-week scan for early diagnosis of fetal congenital anomalies in the cell-free DNA era. 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 . Int J Urol. Reviewed and validity confirmed 2011. The American Urological Association (AUA) 2007 guideline on prostate cancer notes that conclusions on the outcomes of HIFU cannot be determined as there is minimal data available on this treatment. Replaced term women with individual within clinical indications. In 2015, The U.S. Food and Drug Administration (FDA) approved two devices for use in prostate cancer. The uterus, cervix, adnexa, and cul-de-sac region should be examined. ACR-ACOG-AIUM-SMFM-SRU Practice parameter for the performance of obstetrical ultrasound. 2011; 3(3):329-338. 2008; 102(7):786-792. Added not medically necessary statement for TULSA. Crouzet S, Blana A, Murat FJ, et al. Eur Urol. An abnormal finding on second-trimester ultrasonography that identifies a major congenital anomaly significantly increases the risk of genetic abnormality and warrants further counseling, including the discussion of various prenatal testing strategies. Zika virus was first reported in South America in May 2015 and since that time has now appeared in the United States. 2015; 62(137):140-143. Urology. 2014; 106(5). Prostate cancer is the most commonly diagnosed cancer in men, accounting for 19% of all new cancer cases. In October 2017, ACOG and SMFM released an updated version of the practice advisory based upon updated Centers for Disease Control and Prevention (CDC) recommendations and recently published guidance. Gelet A, Chapelon JY, Poissonnier L, et al. 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. After excluding the drop-out groups the results remained similarly statistically significant. August 15, 2019. Dupr A, Melodelima D, Prol D, et al. We are now accepting all Anthem Blue Cross Blue Shield patients. Bonekamp and associates (2019) performed a quantitative analysis of viable prostate tissue volume reduction at 12 months post-procedure. Updated Coding section to add ICD-10-CM diagnosis codes O09.00-O09.03, O09.811-O09.829. Updated Coding section with 10/01/2022 ICD-10-CM changes; added O35.00X0-O35.9XX9 replacing O35.0XX0-O35.9XX9. Clarification to Not Medically Necessary Statement. Ultrasound in pregnancy. American College of Obstetricians and Gynecologists (ACOG). HIFU is a non-invasive ablative procedure which has the advantage of sparing surrounding tissue which may reduce postoperative morbidity and hasten recovery. Pak J Pharm Sci. Transrectal high-intensity focused ultrasound for treatment of patients with stage T1b-2n0m0 localized prostate cancer: a preliminary report. Transrectal high-intensity focused ultrasound: minimally invasive therapy of localized prostate cancer. Updated References. November 6, 2015. 2011; 108(8 Pt 2):E196-E201. No ionizing radiation (x-ray) is used in ultrasound imaging. Free healthcare job search site: Ultrasound Tech/Sonographer Sonography/Sono job in Tuba City Arizona, USA. 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. In some states, insurance must cover . 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. 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). The majority of attributable AEs were grade 1 or 2. Radiother Oncol. In addition, there are limitations on tissue tolerance at sites previously irradiated. August 27, 2020. Guidelines for diagnostic imaging during pregnancy and lactation. Geiger D, Napoli A, Conchiglia A, et al. 510K Premarket notification. Ultrasound is currently being used as a therapeutic treatment, for example, lithotripsy to disintegrate kidney stones. Ideally the ultrasound is done at the same appointment as the screening mammogram. The price of a diagnostic mammogram averages from $172 under Medicare to $239 with private insurance. When high-intensity ultrasound waves are used in place of low-intensity, body tissue absorbs, rather than reflects the energy. Systematic review of high-intensity focused ultrasound ablation in the treatment of breast cancer. Removed ICD-9 codes from Coding section. 2017; 120(2):246-256. 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. The five HIFU trials included a total of only 136 individuals. 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. J Urol. High-intensity focused ultrasound for treatment of pancreatic cancer: a systematic review. The focus of this study was the use of prostate specific antigen (PSA) as a predictor of disease-free survival after HIFU, not the outcomes related to HIFU treatment. Eur Urol Open Sci. Safety trial of high-intensity focused ultrasound therapy for pancreatic cancer. World J Gastroenterol. There are currently more than 125 Treatment Centers around the world using Insightec's Exablate Neuro platform to treat Essential Tremor. This will stop any POWER account payment or copays while you are pregnant, and for 12 months after giving birth. Available at: U.S. National Library of Medicine. Updated Discussion, References and Websites for Additional Information sections. Shoji S, Nakano M, Nagata Y, et al. ACOG Practice Bulletin 175. MedlinePlus. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Available at. 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. grievance or appeal. AIUM practice guideline for the performance of obstetric ultrasound examinations. 2017; 119(6):896-904. 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. 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 Pregnant Women. The mean reduction in the NRS score was significant between MRgFUS and placebo (3.6 3.1 versus 0.7 2.4). Reformatted Coding section. Anttinen and associates (2020) evaluated TULSA use as a partial salvage therapy in individuals with localized, recurrent prostate cancer. ; AUA Prostate Cancer Clinical Guideline Update Panel. Focal therapies are proposed as less invasive treatment options when compared to radical prostatectomy or radiation therapy. CA/SG/Anthem Platinum PPO 15/250/10%/6BPB/01-22 Page 1 of 13 Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered ServicesCoverage Period: 01/01/2022 - 12/31/2022 Anthem BlueCross Coverage for: Individual + Family | Plan Type: PPO Anthem Platinum PPO 15/250/10% The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. 2015; 2015(7):CD007058. J Urol. 2021. 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 . PSA nadir as a predictive factor for biochemical disease-free survival and overall survival following whole-gland salvage HIFU following radiotherapy failure. American College of Radiology (ACR). 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 . An mpMRI, a transrectal ultrasound guided biopsy and a cystoscopy were performed at 12 months post-procedure. MRI-TULSA resulted in an 88% reduction of viable prostate tissue volume. High intensity focused ultrasound (HIFU): A surgical procedure that uses focused high energy sound waves to destroy target tissues in the body. However, the change from baseline in MEDD intake was not statistically significant, although the authors noted a trend towards a statistically significant change. Ultrasound is currently being used as a therapeutic treatment, for example, lithotripsy to disintegrate kidney stones. Adverse events included grade 1 or 2 hematuria, urinary tract infections or acute urinary retention, and grade 3 epididymitis. 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). 2015 Mar;34(3):435-440. The baseline median PSA of 7.6 ng/ml decreased to 0.23 ng/ml at 12 months follow-up. Focused ultrasound for the treatment of bone metastases: effectiveness and feasibility. Hemi salvage high-intensity focused ultrasound (HIFU) in unilateral radiorecurrent prostate cancer: a prospective two-centre study. J Urol. 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. FAQ 133, July 2021. 2017; 71(2):267-273. Updated Coding section with 10/01/2016 ICD-10-CM diagnosis code changes. Individuals received either whole gland (n=8) or partial (n=8) ablation. 2015; 28(3 Suppl):1097-1100. Medicare Supplement Plan F is great because it provides the most coverage of the 10 currently available MedSup plans. We reserve the right to review and update Clinical UM Guidelines periodically. Transrectal high-intensity focused ultrasound using the Ablatherm device in the treatment of localized prostate carcinoma. Clin Orthop Relat Res. These results were not included in the primary efficacy analysis. HAIFA, Israel- MIAMI, Dec. 22, 2022/CNW/ -- Insightec, a global healthcare company dedicated to using acoustic energy to transform patient care, announced today that Anthem is the third national. Available at: Second and Third Trimester Vaginal Bleeding. Our radiologists are among the most . Step 1: Report your pregnancy to your health plan. Primary pain palliation and local tumor control in bone metastases treated with magnetic resonance-guided focused ultrasound. Cochrane Database Syst Rev. Post-treatment biopsies were available in 77% of subjects. MPTAC review. Federal and State law, as well as contract language, and Medical Policy take precedence over Clinical UM Guidelines. A total of 23 studies comprised of 1157 individuals were included. Muto S, Yoshii T, Saito K, et al. This guideline was reviewed and validated in 2011. Rombouts SJ, Vogel JA, van Santvoort HC, et al. Alldred SK, Takwoingi Y, Guo B, et al. Yutkin V, Ahmed HU, Donaldson I, et al. 2005; 12(2):2593-2597. Elterman D, Li W, Hatiboglu G, et al. Focal therapy with high-intensity-focused ultrasound in the treatment of localized prostate cancer. In the obese patient, expectations regarding visualization of fetal anatomy should be tempered. Crouzet S, Murat FJ, Pommier P, et al. 2001; 15(4):437-440. To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the member's card. Chaussy C, Thuroff S, Rebillard X, Gelet A. MPTAC review. 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. Cancer. To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the member's card. 2022 Prenatal ultrasound diagnosis (Dx) codes Please note that this information is a guideline. Beerlage HP, Thuroff S, Debruyne FM, et al. ACOG Practice Bulletin Number 183, October 2017. AIUM-ACR-ACOG-SMFM-SRU Practice parameter for the performance of standard diagnostic obstetric ultrasound examinations. 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.