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. 2000; 4(3):183-187. Cancer. Available at. Control of prostate cancer by transrectal HIFU in 227 patients. Updated Description, Discussion, References and Websites for Additional Information sections. 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. Updated Discussion and References section. 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. The mean follow-up period was 6.4 years (range, 0.2-13.9). American College of Obstetricians and Gynecologists (ACOG). Principles and results of high-intensity focused ultrasound for localized prostate cancer. 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. Available at: Centers for Medicare and Medicaid Services. Pain palliation for localized metastatic bone pain Bone pain is a common complaint for individuals with metastatic cancer to the bone. Anthem BlueCross Coverage for: Individual + Family | Plan Type: HMO Anthem Value Ded HMO 750/25/40/25% The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. 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. Updated Description, Discussion, References and Websites for Additional Information sections. 2015; 2015(6):CD001451. Invest Radiol. 2021; 35(4):497-505. The 2021 American Urological Association (AUA) published a guideline on renal mases and localized renal cancer. 2012; 116(3):201-205. There were no treatment-related AEs. 2012; 118(12):3071-3078. For more information about your rights, look at the explanation of benefits you will receive for that medical claim. Revised 2020. Indiana Medicaid provides coverage to pregnant women through two programs. 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. Palliative Care. Guideline for the management of clinically localized prostate cancer: 2007 update. ACOG Practice Bulletin 175. Updated Coding section; added ICD-10-CM code ranges O98.111-O98.119, O99.310-O99.313, O99.320-O99.323, O99.330-O99.333. The authors reviewed 9 studies with a total of 167 participants. You bet! 2008; 38(3):192-199. This document addresses ultrasound ablative therapy for the treatment of oncologic conditions. High-intensity focused ultrasound for treatment of pancreatic cancer: a systematic review. The difference in response rates between MRgFUS and placebo at 3 months was significant (64.3% versus 20.0%). Hemi salvage high-intensity focused ultrasound (HIFU) in unilateral radiorecurrent prostate cancer: a prospective two-centre study. (i.e. Lawrentschuk N, Finelli A, Van der Kwast TH, et al. 2015; 102(8):873-882. Medicare Supplement Plan F is great because it provides the most coverage of the 10 currently available MedSup plans. The recommendations are based on limited data. 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. MPTAC review. 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. 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. The prospective, nonrandomized, investigator-initiated, single-arm, single-center phase 1 study included 11 individuals with localized, histopathologically verified, radio-recurrent prostate cancer. 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. Updated References and Websites for additional information sections. The mean reduction in the NRS score was significant between MRgFUS and placebo (3.6 3.1 versus 0.7 2.4). Please enter a valid 5-digit Zip Code. Systematic review of innovative ablative therapies for the treatment of locally advanced pancreatic cancer. Eur Urol. 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. In the 25 participants that were able to tolerate a complete treatment, 72% (18/25) reported significant pain reduction of at least 2 points on the VAS scale, 24% (6/25) reported no reduction in pain and 4% (1/25) reported an increase in pain levels. Although the exact mechanism of analgesic action of MRgFUS in pain palliation is unknown, studies have pointed to a few explanations. 2017. Transurethral ultrasound ablation (TULSA), which delivers directional thermal ultrasound via a catheter inserted into the urethra, is specific to prostate cancer. National Coverage Determination: Ultrasound diagnostic procedures. Bonekamp D, Wolf MB, Roethke MC, et al. MedlinePlus. Our radiologists are among the most . Transrectal high-intensity focused ultrasound: minimally invasive therapy of localized prostate cancer. Available at: High Intensity Ultrasound System for Prostate Tissue Ablation (TULSA-PRO System). Sonablate was classified as a class II device. Early prospective studies evaluating MRgFUS reported promising results. Retroperitoneal ultrasound (US) studies represent the ultrasonic imaging of retroperitoneal organs for the diagnosis and management of abnormalities that occur within the retroperitoneum. Due to variances in utilization patterns, each plan may choose whether to adopt a particular Clinical UM Guideline. Peek and associates (2015) conducted a systematic review of the use of HIFU in breast cancer. Uchida T, Sanghvi NT, Gardner TA, et al. 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 This prospective case series did not compare HIFU long-term survival and morbidity rates with the rates of other standard treatments. MPTAC review. Available at: American Institute of Ultrasound in Medicine (AIUM). MedlinePlus. Anttinen M, Mkel P, Viitala A, et al. Postpartum hemorrhage. Transrectal high-intensity focused ultrasound using the Ablatherm device in the treatment of localized prostate carcinoma. Nat Rev Clin Oncol. Updated Discussion, References and Websites for Additional Information sections. You should contact Anthem Blue Cross and Blue Shield directly to appeal denial of coverage for medical claims by calling 1855- -641-4862. The authors theorized that the high rate of salvage treatment at 3 years follow-up could be attributed to suboptimal staging and treatment. TULSA was developed as an alternative method of prostate tissue ablation. 2014; 20(28):9570-9577. HIP Maternity will cover enhanced benefits . This document does not address nuchal translucency. Baco E, Gelet A, Crouzet S, et al. MPTAC review. MPTAC review. 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. 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. BJU Int. Focused ultrasound for the treatment of bone metastases: effectiveness and feasibility. 2015; 194(1):114. 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. 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. Adult Cancer Pain (V2.2022). Practice Advisory Interim Guidance for Care of Obstetric Patients During a Zika Virus Outbreak. Colombel M, Gelet A. The value of adding a universal booking scan to an existing protocol of routine mid-gestation ultrasound scan. BJU Int. Moved content of MED.00119 High Intensity Focused Ultrasound (HIFU) for Oncologic Indications to new clinical utilization management guideline document with the same title. Local recurrence of prostate cancer after external beam radiotherapy: early experience of salvage therapy using high-intensity focused ultrasonography. Urology. The location you tried did not return a result. 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. Zip Code or City, State . Participants included those who could not undergo or refused all other available options for pain palliation. The current evidence is insufficient to support the use of HIFU as a generally accepted oncological treatment. HIFU was comparable to the median survival in standard chemotherapy. Update date: March 4, 2022. In 2021, Nair and colleagues reported the 3-year outcomes of the participants in the Chin study. AIUM Practice Parameter for the Performance of Detailed Diagnostic Obstetric Ultrasound Examinations Between 12Weeks 0Days and 13Weeks 6Days. Klotz L, Pavlovich CP, Chin J, et al. HIFU or MRgFUS has also been studied as a potential treatment of various cancers. 2000; 37(6):695-701. J Natl Cancer Inst. To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the member's card. *Coverage includes fertility preservation . Available at: U.S. National Library of Medicine. Influence of high intensity focused ultrasound (HIFU) treatment to the pancreatic function in pancreatic cancer patients. 2017; 3:CD012600. Breast MRI costs an average $615 under Medicare . 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. 2016; 70(3):447-455. MPTAC review. 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). Alternatively, the reduced tumor mass caused by thermal ablation may have an analgesic effect. While the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines (CPG) in Oncology for Adult Cancer Pain (V2.2022) document notes that the palliative effects of HIFU have been demonstrated in several small studies, no recommendation for or against the use of HIFU for pain palliation was given. Pain severity was measured using a 10-point pain scale questionnaire. 2000; 14(6):519-528. Chen L, Wang K, Chen Z, et al. Technology insight: High-intensity focused ultrasound for urologic cancers. 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 . Albisinni S, Aoun F, Bellucci S, et al. A set of individuals who were positive for insignificant disease at 12 months (n=4) or clinically significant disease at 12 months (n=5) required salvage treatment. World J Gastroenterol. Ahhhhh! 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). Similar to prostate cancer, there is a lack of randomized trials comparing HIFU to standard treatment options. 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 . The primary endpoint was the proportion of individuals who achieved a 75% or greater reduction in PSA at 12 months post-procedure. 2015; 28(3 Suppl):1097-1100. Eur Urol. On October 9, the FDA granted de novo clearance to SonaCare Medical, LLC (Charlotte, NC) to market the Sonablate 450 for prostate tissue ablation. 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. Gardner TA, Koch MO. Summary of Safety and Effectiveness Data (SSED). Eur Urol Open Sci. 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. Shoji S, Nakano M, Nagata Y, et al. 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. 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. Surgery: MRgFUS-non invasive treatment for patients with painful bone metastasis. Find top doctors who perform Rectal Ultrasound near you in Anthem, AZ. Updated September 20, 2021. There are currently two ultrasound ablative techniques. Clarification to Not Medically Necessary Statement. For pregnant women with laboratory evidence of Zika infection, ultrasound to evaluate for fetal abnormalities consistent with congenital Zika virus syndrome is recommended. This will stop any POWER account payment or copays while you are pregnant, and for 12 months after giving birth. The Summary of Benefits and Coverage (SBC) document will help you choose a health plan.
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