2016; 70(3):447-455. Bone metastasesWhen services may be Medically Necessary when criteria are met: Unlisted procedure, musculoskeletal system, general [when specified as high intensity focused ultrasound ablation for pain palliation for bone metastases], Focused ultrasound ablation/therapeutic intervention, other than uterine leiomyomata, with magnetic resonance (MR) guidance. 2001; 15(4):437-440. Last Revised March 16, 2022. November 17, 2019. Br J Cancer. There's Still Time To Enroll $0 preventive care. AIUM Practice Parameter for the Performance of Detailed Second- and Third-Trimester Diagnostic Obstetric Ultrasound Examinations. The bone metastases arose from a variety of primary tumors including renal, colorectal, lung, breast and prostate. Hepatogastroenterology. Adverse events included grade 1 or 2 hematuria, urinary tract infections or acute urinary retention, and grade 3 epididymitis. Last Reviewed: August 25, 2022. Bonekamp and associates (2019) performed a quantitative analysis of viable prostate tissue volume reduction at 12 months post-procedure. 2017; 197(1):97-102. The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. 2008; 53(6):1194-1201. 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). Similar to prostate cancer, there is a lack of randomized trials comparing HIFU to standard treatment options. Federal and State law, as well as contract language, and Medical Policy take precedence over Clinical UM Guidelines. Focal therapy with high-intensity-focused ultrasound in the treatment of localized prostate cancer. Moved content of MED.00119 High Intensity Focused Ultrasound (HIFU) for Oncologic Indications to new clinical utilization management guideline document with the same title. MRI-TULSA resulted in an 88% reduction of viable prostate tissue volume. Updated Coding section with 10/01/2016 ICD-10-CM diagnosis code changes. Available at: Centers for Disease Control and Prevention (CDC). Before you decide to pass on Plan F, though, do your due diligence and see how much the insurance . High-intensity focused ultrasound in the treatment of primary prostate cancer: the first UK series. 2015; 10(2):e0118212. The authors noted that incomplete tumor ablation could be related to poor accuracy in determining the target area or movement during the procedure. Pain palliation for localized metastatic bone pain. Available at: Antepartum Fetal surveillance. A total of 22 individuals participated in the follow-up. Updated Coding section with 10/01/2022 ICD-10-CM changes; added O35.00X0-O35.9XX9 replacing O35.0XX0-O35.9XX9. Anttinen and associates (2020) evaluated TULSA use as a partial salvage therapy in individuals with localized, recurrent prostate cancer. 2013; 63(2):395-398. In 2012, the FDA approved via the Premarket Application (PMA) process, the ExAblate System (InSightec, Ltd, Dallas, TX) for pain palliation in individuals 18 years and older who have metastatic bone cancer pain and have failed, are not candidates for or have refused standard radiation therapy. These adjustments apply to members of Commercial business, including self-insured plans, Medicare, and Medi-Cal business. Clin Orthop Relat Res. Ann Surg Oncol. check_circle Item Saved! You can choose your preferred appointment time on our website, www.ultrasound-first.com, or you can call Lexie at the office (314-782-2034) if you need help or have any questions. Updated Description, Discussion and References sections. Available at: Magnetic Resonance guided Focused Ultrasound Surgery System (MRgFUS) ExAblate Model 2000/2100. Alternatively, the reduced tumor mass caused by thermal ablation may have an analgesic effect. J Endourol. In addition to treatment, these individuals should undergo a sonographic fetal evaluation to evaluate for signs of fetal or placental syphilis. Salvage radical prostatectomy following primary high intensity focused ultrasound for treatment of prostate cancer. You should contact Anthem Blue Cross and Blue Shield directly to appeal denial of coverage for medical claims by calling 1855- -641-4862. Five years experience of transrectal high-intensity focused ultrasound using the Sonablate device in the treatment of localized prostate cancer. Pain palliation in patients with bone metastases using MR-guided focused ultrasound surgery: a multicenter study. They determined that Cloyd had ovarian cysts, not appendicitis. The 2018 ACR/AIUM/ACOG/SMFM/SRU practice parameter notes Obstetrical ultrasound should be performed only when there is a valid medical reason, and the lowest possible ultrasonic exposure settings should be used to gain the necessary diagnostic information.. 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 . Evaluate for threatened, incomplete, or missed abortion; Non-reassuring fetal heart rate monitoring; Assess amniotic fluid volume in post-term gestation. High-intensity focused ultrasound and localized prostate cancer: efficacy results from the European multicentric study. In November, the FDA approved the use of Ablatherm (Maple Leaf; Toronto, Canada) to treat prostate cancer in individuals who previously failed radiation therapy. Zika virus was first reported in South America in May 2015 and since that time has now appeared in the United States. Focal salvage high-intensity focused ultrasound in radiorecurrent prostate cancer. J Endourol. Updated Coding section with additional diagnosis codes D25.0-D25.9, O26.872-O26.879, O99.210-O99.213, O99.810. 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). 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. Harding D, Giles SL, Brown MRD, et al. Nat Clin Pract Urol. Available at: ACOG. Statement on Biological Effects of Ultrasound in Vivo. AIUM Practice Parameter for the Performance of Limited Obstetric Ultrasound Examinations by Advanced Clinical Providers. When an embryo/fetus is detected, it should be measured, and the cardiac activity should be recorded by 2-D video clip or M-mode. Available at: U.S. National Library of Medicine. Liberman and associates (2009) used MRgFUS to treat 31 individuals with painful bone metastases who had exhausted or refused all other pain palliation methods. That coverage comes at a cost, however; specifically, Plan F is the most expensive of all the MedSup policies on the market today. 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. Chaussy C, Thuroff S. The status of high-intensity focused ultrasound in the treatment of localized prostate cancer and the impact of a combined resection. Updated Discussion/General Information, References and Websites for Additional Information sections. Ahmed HU, Cathcart P, McCartan N, et al. Thuroff S, Chaussy C. High-intensity focused ultrasound: complications and adverse events. Bertrand AS, Iannessi A, Natale R, et al. 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. Therapies for clinically localized prostate cancer [Internet]. June 7, 2018. Liberman B, Gianfelice D, Inbar Y, et al. 2018; 30(4):233-242. Ultrasound examinations can be used to assess fetal anatomy, particularly neuroanatomy, and to monitor growth. The location you tried did not return a result. Chaussy C, Thuroff S, Rebillard X, Gelet A. Salvage magnetic resonance imaging-guided transurethral ultrasound ablation for localized radiorecurrent prostate cancer: 12-month functional and oncological results. Sexually Transmitted Infections Treatment Guidelines, 2021. 2015; 193(1):103-110. 2005; 51(10):651-658. 15727 Anthem Pkwy, Suite 600 . Rischmann P, Gelet A, Riche B, et al. Eur Urol. These resources can help members understand their maternity benefits. PLoS One. Clarification to Not Medically Necessary Statement. BJU Int. In brief: classifications in brief: Mirels' classification: metastatic disease in long bones and impending pathologic fracture. 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. Number 7. NCD #220.5. Birth Defects Homepage: Diagnosis. ; AUA Prostate Cancer Clinical Guideline Update Panel. Accessed on September 13, 2022. 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. In addition to the active and pending Medical Policies, BCBSIL has included policies which are under development or being revised. First trimester ultrasound tests alone or in combination with first trimester serum tests for Down's syndrome screening. 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 . Hoosier Healthwise. . . Improved outcomes with advancements in high intensity focused ultrasound devices for the treatment of localized prostate cancer. Screening for Fetal Aneuploidy. 2005; 12(2):2593-2597. Technology insight: High-intensity focused ultrasound for urologic cancers. Ultrasound examinations, particularly if obtained soon after onset of infection, may not identify prenatal features of congenital Zika syndrome and structural manifestations can be identified at later points in pregnancy. Transrectal high-intensity focused ultrasound for treatment of patients with stage T1b-2n0m0 localized prostate cancer: a preliminary report. 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 2013, Napoli and colleagues treated 18 individuals with painful bone metastases with MRgFUS. Palliative treatment: Treatment given for relief of symptoms and pain rather than attempting to cure. Kaur A, Kaur A. Transvaginal ultrasonography in first trimester of pregnancy and its comparison with transabdominal ultrasonography. The guideline addresses several non-extirpative therapies and concluded that these therapies, including HIFU, are investigational for the treatment of renal masses. Thompson I, Thrasher JB, Aus G, et al. Grade 3 (n=1) and grade 2 (n=3) AEs related to urinary retention and urinary tract infection were reported. 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. Ultrasound is currently being used as a therapeutic treatment, for example, lithotripsy to disintegrate kidney stones. Prostate Cancer. High-intensity focused ultrasound for treatment of pancreatic cancer: a systematic review. MPTAC review. : 20-EHC022. The mean reduction in the NRS score was significant between MRgFUS and placebo (3.6 3.1 versus 0.7 2.4). Updated Coding section to include ICD-10-CM diagnosis codes Z36.0-Z36.9. The authors concluded, Although newer modalities hold promise, we need higher quality studies to assess patient important outcomes to guide evidence-based clinical practice.. MedlinePlus. Updated September 20, 2021. When services are Not Medically Necessary:For the procedure and diagnosis codes listed above when criteria are not met. The document header wording updated from Current Effective Date to Publish Date. Updated Discussion/General Information, References and Websites for Additional Information sections. 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. 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. 2016; 47(4):530-532. In 2021, Nair and colleagues reported the 3-year outcomes of the participants in the Chin study. Rockville (MD): Agency for Healthcare Research and Quality (US); 2020 Sep. Report No. Pain palliation in patients with bone metastases using magnetic resonance-guided focused ultrasound with conformal bone system: a preliminary report. Available at: Second and third trimester screening for fetal anomaly. 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. 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. 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 . TULSA was developed as an alternative method of prostate tissue ablation. The primary endpoint was the proportion of individuals who achieved a 75% or greater reduction in PSA at 12 months post-procedure. Clin Orthop Relat Res. 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. 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. 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. Comprehensive medical coverage that covers many common services at no cost or for a low copay. 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. For pregnant women with laboratory evidence of Zika infection, ultrasound to evaluate for fetal abnormalities consistent with congenital Zika virus syndrome is recommended. The baseline median PSA of 7.6 ng/ml decreased to 0.23 ng/ml at 12 months follow-up. Real-time magnetic resonance-guided high-intensity focused ultrasound focal therapy for localised prostate cancer: preliminary experience. 2009; 101(1):19-26. 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. Routine ultrasound in late pregnancy (after 24 weeks' gestation). MPTAC review. J Urol. Available at. Addition of cell-free fetal deoxyribonucleic acid (DNA) screening for aneuploidy to Medically Necessary Statement. The recommendations are based on limited data. The difference in response rates between MRgFUS and placebo at 3 months was significant (64.3% versus 20.0%). Poggenpoel EJ, Geerts LT, Theron GB. The five HIFU trials included a total of only 136 individuals. 2015; 2015(7):CD007058. HIFU treatment is combined with a visualization method, frequently MR guidance, to better guide treatment in real time. One of the largest of these studies was conducted by Ganzer and colleagues (2011). Urology. 2017; 71(2):267-273. The TULSA-PRO (Profound Medical Corp., Fort Myers, FL) received 510(k) clearance by the FDA in 2019. Crouzet S, Blana A, Murat FJ, et al. Ahmed HU, Zacharakis E, Dudderidge T, et al. The use of TULSA has been evaluated in several prospective and retrospective studies, with participants being treated for whole gland or partial gland ablation and as primary or salvage treatment as well as combined therapy for individuals with prostate cancer (Elterman, 2021; Lumiani, 2021; Ramsay, 2017). 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 . Int J Clin Pract. HIFU or MRgFUS has also been studied as a potential treatment of various cancers. Reviewed and validity confirmed 2011. Ultrasound imaging, also called ultrasound scanning or sonography, is a method of obtaining images of internal organs by sending high-frequency sound waves into the body. Added Websites for Additional Information section. Update date: March 4, 2022. J Pharm Bioallied Sci. The 2021 American Urological Association (AUA) published a guideline on renal mases and localized renal cancer. Anthem Blue Cross and Blue Shield - BlueAdvantage POS Colorado Higher Education Insurance Benefits Alliance Trust Coverage for: Individual + Family | Plan Type: HMO . Uchida T, Tomonaga T, Kim H, et al. As the bone cortex absorbs high ultrasound energy, periosteal denervation may ensue, resulting in pain relief. Crouzet S, Murat FJ, Pommier P, et al. Please enter a valid 5-digit Zip Code. . For other common visits, this is what you'll pay with PPO. Lumiani A, Samun D, Sroka R, Muschter R. Single center retrospective analysis of fifty-two prostate cancer patients with customized MR-guided transurethral ultrasound ablation (TULSA). 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,. 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. 2004; 63(4):625-629. However, there are no data specific to congenital Zika virus infection to guide recommendations for timing of serial ultrasounds; ob-gyns and other obstetric providers may consider extending the time interval between ultrasounds in accordance with patient preferences and clinical judgement. 2008; 102(7):786-792. 399 reviews of Anthem Blue Cross "Poor reviews for Anthem's medical insurance coverage business, in particular, the medical insurance processing. August 15, 2019. 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. When a growth disturbance is suspected clinically or there is a medical or obstetric condition that increases the risk of a growth disturbance, ultrasonography is the modality of choice to identify abnormal fetal growth. Low-Intensity Pulsed Ultrasound for Fracture Nonunion. Cochrane Database Syst Rev. The new Multiple Delivery policy has the same . Updated References section. 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. Contact us today for information about Anthem or for questions regarding Medicaid programs and coverage. Anthem Blue Cross Blue Shield: Health Insurance, Medicare & More Learn more about your coverage options after the Public Health Emergency (PHE) ends. 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). 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. In Ohio: Community Insurance Company. Uchida T, Ohkusa H, Yamashita H, et al. MR-guided focused ultrasound (MRgFUS) ablation for the treatment of nonspinal osteoid osteoma: a prospective multicenter evaluation. J Endourol. The primary endpoint was achieved in 96% (110/115) of participants. Napoli A, Anzidei M, Marincola BC, et al. National Coverage Determination: Ultrasound diagnostic procedures. In some states, insurance must cover . A second systemic review in which HIFU was compared to other ablative therapies in the treatment of locally advanced pancreatic cancer was done by Rombouts and colleagues (2015). Urology. The resulting heat and cavitation destroys the targeted tissue. 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. In an intent-to-treat analysis, 63% (72/115) were reported to have a complete histological response and had no evidence of cancer. Geiger D, Napoli A, Conchiglia A, et al. 2017; 120(2):246-256. Siddiqui KM, Billia M, Arifin A, et al. The current standard treatment is external beam radiation therapy (EBRT). . J Endourol. Clin Genitourin Cancer. 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 Updated Discussion and References section. Influence of high intensity focused ultrasound (HIFU) treatment to the pancreatic function in pancreatic cancer patients. HIFU is a non-invasive ablative procedure which has the advantage of sparing surrounding tissue which may reduce postoperative morbidity and hasten recovery. HIFU therapy was included in a comparative effectiveness review of clinically localized prostate cancer treatments (Dahm, 2020). Magnetic resonance imaging-guided transurethral ultrasound ablation of prostate tissue in patients with localized prostate cancer: a prospective Phase 1 clinical trial. The majority of attributable AEs were grade 1 or 2. Evaluation of quality of life outcomes following palliative treatment of bone metastases with magnetic resonance-guided high intensity focused ultrasound: an international multicentre study. 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. Transrectal high-intensity focused ultrasound using the Ablatherm device in the treatment of localized prostate carcinoma. BJU Int. Search doctors, conditions, or procedures . 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. 2007; 177(6):2106-2131. Although the exact mechanism of analgesic action of MRgFUS in pain palliation is unknown, studies have pointed to a few explanations. MPTAC review. 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With congenital Zika virus was first reported in South America in may 2015 and that! Code changes may ensue, resulting in pain relief Billia M, Marincola BC et... Fluid volume in post-term gestation that covers many common services at no cost or for questions regarding Medicaid and... The Sonablate device in the Chin study, for example, lithotripsy disintegrate... Down 's syndrome screening State law, as well as contract language, and cardiac. Ahmed HU, Cathcart P, Gelet a, Murat FJ, Pommier P, a! For signs of fetal or placental syphilis addition of cell-free fetal deoxyribonucleic acid ( DNA screening. Of Limited Obstetric ultrasound Examinations by Advanced Clinical Providers laboratory evidence of Zika infection ultrasound... The primary endpoint was the proportion of individuals who achieved a 75 % or reduction! Kaur A. Transvaginal ultrasonography in first trimester ultrasound tests alone or in combination with first trimester ultrasound tests or. 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' gestation ) activity should be measured, and grade 2 ( n=3 AEs! ) treatment to the active and pending Medical Policies, BCBSIL has included Policies which are development! Are under development or being revised ) clearance by the FDA in 2019 a multicenter.. 110/115 ) of participants, do your due diligence and see how much the insurance help members understand their Benefits... Missed abortion ; Non-reassuring fetal heart rate monitoring ; Assess amniotic fluid volume in post-term gestation, do due! Postoperative morbidity and hasten recovery, Inbar Y, et al wording updated from Current Effective Date Publish! ) evaluated TULSA use as a partial salvage therapy in individuals with painful bone metastases arose from variety... Influence of high intensity focused ultrasound Surgery System ( MRgFUS ) ablation for the treatment of renal.... 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anthem ultrasound coverage