2002; 59(3):394-398. Pathological, oncologic and functional outcomes of a prospective registry of salvage high intensity focused ultrasound ablation for radiorecurrent prostate cancer. 2014; 96(9):743-751. At 2 weeks follow-up, all individuals experienced a decrease in VAS pain scores from baseline (1.5-5). MedlinePlus. 2014; 11(6):303. Contact us today for information about Anthem or for questions regarding Medicaid programs and coverage. 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. Napoli A, Anzidei M, Marincola BC, et al. Chen L, Wang K, Chen Z, et al. Grade 3 (n=1) and grade 2 (n=3) AEs related to urinary retention and urinary tract infection were reported. Nat Rev Clin Oncol. Focal therapy with high-intensity-focused ultrasound in the treatment of localized prostate cancer. grievance or appeal. 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. 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. The guideline addresses several non-extirpative therapies and concluded that these therapies, including HIFU, are investigational for the treatment of renal masses. HIFU has been proposed as a treatment for multiple oncologic conditions. Coverage varies some from plan to plan, so check your plan's specifics. 2017; 120(2):246-256. . J Endourol. 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. Sexually Transmitted Infections Treatment Guidelines, 2021. MPTAC review. High-intensity focused ultrasound and localized prostate cancer: efficacy results from the European multicentric study. Indiana Medicaid. 2020; 22:79-87. 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). Bone metastases are common in breast and prostate cancer (Liberman, 2009). 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 Urol Oncol. CPT Only - American Medical Association, MED.00057 MRI Guided High Intensity Focused Ultrasound Ablation for Non-Oncologic Indications, CG-SURG-61 Cryosurgical, Radiofrequency or Laser Ablation to Treat Solid Tumors Outside the Liver, https://acsearch.acr.org/docs/69397/Narrative, https://www.auanet.org/guidelines-and-quality/guidelines/renal-mass-and-localized-renal-cancer-evaluation-management-and-follow-up, https://www.astro.org/uploadedFiles/_MAIN_SITE/Patient_Care/Clinical_Practice_Statements/Content_Pieces/ClinicallyLocalizedProstateCancer.pdf, https://www.accessdata.fda.gov/cdrh_docs/pdf15/k153023.pdf, https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K172721, https://www.accessdata.fda.gov/cdrh_docs/pdf19/K191200.pdf, https://www.accessdata.fda.gov/cdrh_docs/pdf11/p110039b.pdf, http://www.cancer.org/treatment/understandingyourdiagnosis/bonemetastasis/bone-metastasis-treating-problems-caused, http://www.cdc.gov/cancer/prostate/basic_info/treatment.htm, https://medlineplus.gov/prostatecancer.html, https://www.nlm.nih.gov/medlineplus/palliativecare.html. Updated Description, Discussion, References and Websites for Additional Information sections. Updated Discussion/General Information, Coding and Reference sections. Available at. Int J Urol. BJU Int. 2011; 185(4):1246-1254. In the absence of specific indications, the optimal time for a single ultrasound examination is at 1822 weeks of gestation. Liberman B, Gianfelice D, Inbar Y, et al. 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. 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,. MPTAC review. 2015 Mar;34(3):435-440. November 17, 2019. A total of 23 studies comprised of 1157 individuals were included. Updated Discussion/General Information and Reference sections. Ideally the ultrasound is done at the same appointment as the screening mammogram. The Centers for Medicare and Medicaid Services (CMS) released an updated Relative Value file Jan. 5, that includes updated reimbursement for the neuromuscular ultrasound codes 76881, 76882 and 76883. * Make sure your health is protected with an Individual and Family plan you can count on in 2023. Jawad MU, Scully SP. High intensity focused ultrasound as first line salvage therapy in prostate cancer local relapse after radical prostatectomy: 4-year follow-up outcomes. Updated: June 16, 2022. Available at: Dahm P, Brasure M, Ester E, et al. American College of Radiology (ACR). On October 9, the FDA granted de novo clearance to SonaCare Medical, LLC (Charlotte, NC) to market the Sonablate 450 for prostate tissue ablation. Gelet A, Chapelon JY, Poissonnier L, et al. Bonekamp and associates (2019) performed a quantitative analysis of viable prostate tissue volume reduction at 12 months post-procedure. 2019; 29(1):299-308. 2004; 63(2):297-300. Mirels scoring system: A scoring system based upon lesion characteristics and pain levels used to classify pathologic fracture risk. 2015; 102(3):182-193. 2010; 468(10):2825-2827. 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. Thuroff S, Chaussy C, Vallancien G, et al. Available at: Centers for Medicare and Medicaid Services. Guidelines for diagnostic imaging during pregnancy and lactation. NCCN Clinical Practice Guidelines in Oncology. 2015; 2015(6):CD001451. $0 virtual care, 24/7. August 27, 2020. HIP Maternity will cover enhanced benefits . 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. Providers are responsible for billing the appropriate CPT code, modifier, and diagnosis combinations. 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. The routine use of pulsed Doppler ultrasound to either document or listen to embryonic/fetal cardiac activity is discouraged. 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. 2021. Urology. 2000; 4(3):183-187. Available at: Limited obstetrical ultrasound examination. Blana A, Murat FJ, Walter B, et al. U.S. Food and Drug Administration (FDA). Updated Description, Discussion, References and Websites for Additional Information sections. Ultrasound in pregnancy. Ultrasound examinations can be used to assess fetal anatomy, particularly neuroanatomy, and to monitor growth. Book an appointment today! In those individuals who reported a decrease in pain levels, 50% (9/18) reported complete relief of pain, with 52% reporting significant pain relief beginning 3 days post treatment. After excluding the drop-out groups the results remained similarly statistically significant. Palliative Care. In addition to treatment, these individuals should undergo a sonographic fetal evaluation to evaluate for signs of fetal or placental syphilis. 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. Poggenpoel EJ, Geerts LT, Theron GB. J Ultrasound Med. 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. Rooms for rent in Bury flat and house shares - 3 currently available. Placenta Accreta Spectrum. Routine ultrasound in late pregnancy (after 24 weeks' gestation). Kaur A, Kaur A. Transvaginal ultrasonography in first trimester of pregnancy and its comparison with transabdominal ultrasonography. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. AIUM Practice Parameter for the Performance of Detailed Second- and Third-Trimester Diagnostic Obstetric Ultrasound Examinations. Government Agency, Medical Society, and Other Authoritative Publications: Maternal UltrasoundObstetricPrenatalSonography. 2007; 177(6):2106-2131. Kanthabalan A, Peters M, Van Vulpen M, et al. Focal salvage high-intensity focused ultrasound in radiorecurrent prostate cancer. Management of prostate-specific antigen relapse in prostate cancer: a European Consensus. J Urol. Addition of cell-free fetal deoxyribonucleic acid (DNA) screening for aneuploidy to Medically Necessary Statement. Routine Tests During Pregnancy. Muto S, Yoshii T, Saito K, et al. $0 plans in select areas. Due to variances in utilization patterns, each plan may choose whether to adopt a particular Clinical UM Guideline. The primary endpoint was achieved in 96% (110/115) of participants. The sound wave echoes are recorded and displayed as a real-time visual image. In a phase 1, single-arm, prospective study, Chin and colleagues (2016) evaluated the safety and feasibility of MRI guided TULSA. Statement on Biological Effects of Ultrasound in Vivo. High-intensity focused ultrasound for treatment of pancreatic cancer: a systematic review. Alldred SK, Takwoingi Y, Guo B, et al. Single high intensity focused ultrasound session as a whole gland primary treatment for clinically localized prostate cancer: 10-year outcomes. The NCCN Prostate Cancer CPG (V1.2023) includes a recommendation for individuals with tumor recurrence following radiation therapy to include HIFU as a treatment option (2B recommendation). Ultrasound is currently being used as a therapeutic treatment, for example, lithotripsy to disintegrate kidney stones. Influence of high intensity focused ultrasound (HIFU) treatment to the pancreatic function in pancreatic cancer patients. Update date: March 4, 2022. Common in breast and prostate cancer non-extirpative therapies and concluded that these therapies, including,! Practice Parameter for the treatment of renal masses Anthem or for questions regarding Medicaid programs and coverage relapse radical. 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