2015; 102(8):873-882. Step 2: After you become pregnant, you will join HIP Maternity. check_circle Item Saved! August 27, 2020. 2015; 193(1):103-110. Magnetic resonance imaging-guided transurethral ultrasound ablation of prostate tissue in patients with localized prostate cancer: a prospective Phase 1 clinical trial. 2015; 62(137):140-143. Updated Coding section to add ICD-10-CM diagnosis codes O09.00-O09.03, O09.811-O09.829. MPTAC review. TULSA is considered not medically necessary for any indication, including but not limited to prostate cancer. 2004; 63(2):297-300. Updated Discussion/General Information and Reference sections. * Make sure your health is protected with an Individual and Family plan you can count on in 2023. Accessed on September 13, 2022. 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. J Urol. Prudent use and safety diagnostic ultrasound in pregnancy. Prostate. Reapproved June 16, 2020. 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. Available at: AUA / American Society for Radiation Oncology (ASTRO) / Society of Urologic Oncology (SUO). close combat footage enemy visible bungee fitness dickson tn Tue, Oct 18 2022 Required ultrasound or colonoscopy for select adult patients based on clinical scenario; Ultrasound-first approach for pediatric abdominal and pelvic pain . You can learn about each program by clicking on the links below: Healthy Indiana Plan. Influence of high intensity focused ultrasound (HIFU) treatment to the pancreatic function in pancreatic cancer patients. The current evidence is insufficient to support the use of HIFU as a generally accepted oncological treatment. 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). Approved August 19, 2021. Post-treatment biopsies were available in 77% of subjects. The maternal cervix and adnexa should be examined. Surgery: MRgFUS-non invasive treatment for patients with painful bone metastasis. July 25, 2018. Ultrasound is currently being used as a therapeutic treatment, for example, lithotripsy to disintegrate kidney stones. AIUM Practice Parameter for the Performance of Limited Obstetric Ultrasound Examinations by Advanced Clinical Providers. Two-year results of transurethral resection of the prostate versus four 'less invasive' treatment options. 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. That coverage comes at a cost, however; specifically, Plan F is the most expensive of all the MedSup policies on the market today. Muto S, Yoshii T, Saito K, et al. Initial document development. Revised 2020. 2012; 116(3):201-205. Visit our official site today for more details. J Urol. World J Gastroenterol. Anthem Blue Cross Blue Shield: Health Insurance, Medicare & More Learn more about your coverage options after the Public Health Emergency (PHE) ends. 2020; 22:79-87. The feasibility and safety of high-intensity focused ultrasound as salvage therapy for recurrent prostate cancer following external beam radiotherapy. In addition to treatment, these individuals should undergo a sonographic fetal evaluation to evaluate for signs of fetal or placental syphilis. . The authors reported that salvage TULSA was technically feasible and showed encouraging early results but have not been compared to standard therapy. 2014; 84(5):1157-1162. 2005; 4(3):187-192. Anthem has begun denying coverage for . Peek MC, Ahmed M, Napoli A, et al. Updated Coding section with 10/01/2022 ICD-10-CM changes; added O35.00X0-O35.9XX9 replacing O35.0XX0-O35.9XX9. Researchers used the visual analog pain score (VAS) to measure pain levels. Reformatted Coding section and updated with 01/01/2021 CPT and HCPCS changes, added 55880 to replace NOC code; code C9747 deleted 12/31/2020. MPTAC review. The mean follow-up period was 6.4 years (range, 0.2-13.9). Cochrane Database Syst Rev. A total of 22 individuals participated in the follow-up. 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. Ganzer R, Robertson CN, Ward JF, et al. 15727 Anthem Pkwy, Suite 600 . These Medical Policies serve as guidelines for health care benefit coverage decisions, which may vary according to the different products and benefit plans offered by BCBSIL. Adult Cancer Pain (V2.2022). Available at: High Intensity Ultrasound System For Prostate Tissue Ablation (Focal One). Centers for Disease Control and Prevention (CDC). 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. Uchida T, Ohkusa H, Nagata Y, et al. AIUM-ACR-ACOG-SMFM-SRU Practice parameter for the performance of standard diagnostic obstetric ultrasound examinations. Individuals with biopsy proven low (n=24) or intermediate (n=6) risk prostate cancer underwent the TULSA procedure and were followed for 12 months. 2014; 96(9):743-751. Updated grammar in medically necessary statement regarding maternal risk factors from including but not limited to, hypertension, diabetes, sickle cell disease preeclampsia), substance abuse, or hyperemesis gravidarum to including but not limited to, hypertension, diabetes or sickle cell disease), preeclampsia, substance abuse or hyperemesis gravidarum. The American College of Obstetricians and Gynecologists (ACOG) 2018 Practice Bulletin Ultrasound in Pregnancy lists the following recommendations: The following conclusions are based on good and consistent evidence (Level A): The following conclusions are based on limited or inconsistent evidence (Level B): The following conclusion and recommendation are based primarily on consensus and expert opinion (Level C): The American College of Radiology (ACR), the American Institute of Ultrasound in Medicine (AIUM), ACOG, the Society for Maternal Fetal Medicine (SMFM), and the Society of Radiologists in Ultrasound (SRU) practice parameter (2018) notes: A standard obstetrical ultrasound examination in the first trimester includes evaluation of the presence, size, location, and number of gestational sac(s). Curr Urol Rep. 2003; 4(3):248-252. Indiana Medicaid provides coverage to pregnant women through two programs. ACOG Practice Bulletin 163. Revised title from High Intensity Focused Ultrasound (HIFU) for Oncologic Indications to Ultrasound Ablation for Oncologic Indications. The overall survival (OS) rate was 80%, the progression-free survival (PFS) rate was 94%, and the disease-specific survival rate was 97%. The baseline median PSA of 7.6 ng/ml decreased to 0.23 ng/ml at 12 months follow-up. Nat Clin Pract Urol. 2014; 65(5):907-914. Prostate Cancer. Ahmed HU, Hindley RG, Dickinson L, et al. In 2015, The U.S. Food and Drug Administration (FDA) approved two devices for use in prostate cancer. Early prospective studies evaluating MRgFUS reported promising results. Available at. J Endourol. Zhang M, Liu L, Wang J, et al. * From Jawad MU, Scully SP. 2014; 11(6):303. 2013; 63(2):395-398. Cancer. Mol Urol. The most commonly reported complications included Stress 1 urinary incontinence (18.7%), followed by obstruction of the bladder outlet (16.6%), and acute urinary retention (7.6%). While the analysis showed superior survival rates at 6 and 12 months in the groups which included HIFU in combination therapy, the authors noted that the overall quality of the studies was poor. Added Websites for Additional Information section. ACOG Practice Bulletin Number 229. Bone pain is a common complaint for individuals with metastatic cancer to the bone. Prostate Cancer Prostatic Dis. To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the member's card. Indiana Medicaid for Members. The mean reduction in the NRS score was significant between MRgFUS and placebo (3.6 3.1 versus 0.7 2.4). 2021; 35(4):497-505. MPTAC review. . Clin Oncol (R Coll Radiol). Routine ultrasound in late pregnancy (after 24 weeks' gestation). Government Agency, Medical Society, and Other Authoritative Publications: Maternal UltrasoundObstetricPrenatalSonography. Real-time magnetic resonance-guided high-intensity focused ultrasound focal therapy for localised prostate cancer: preliminary experience. Chen L, Wang K, Chen Z, et al. 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. Available at: Dahm P, Brasure M, Ester E, et al. When high-intensity ultrasound waves are used in place of low-intensity, body tissue absorbs, rather than reflects the energy. 2008; 38(3):192-199. Five years experience of transrectal high-intensity focused ultrasound using the Sonablate device in the treatment of localized prostate cancer. American College of Obstetricians and Gynecologists (ACOG). Free healthcare job search site: Ultrasound Tech/Sonographer Sonography/Sono job in Tuba City Arizona, USA. Prostate cancer is the most commonly diagnosed cancer in men, accounting for 19% of all new cancer cases. The routine use of pulsed Doppler ultrasound to either document or listen to embryonic/fetal cardiac activity is discouraged. Poissonnier L, Chapelon JY, Rouviere O, et al. Magnetic resonance imaging-guided transurethral ultrasound ablation in patients with localised prostate cancer: 3-year outcomes of a prospective Phase I study. 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. Moved content of MED.00119 High Intensity Focused Ultrasound (HIFU) for Oncologic Indications to new clinical utilization management guideline document with the same title. 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. Bricker L, Medley N, Pratt JJ. Pak J Pharm Sci. 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. Urol Oncol. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. June 2021. 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. High-intensity focused ultrasound (HIFU) followed after one to two weeks by radical retropubic prostatectomy: results of a prospective study. Practice Advisory Interim Guidance for Care of Obstetric Patients During a Zika Virus Outbreak. Geiger D, Napoli A, Conchiglia A, et al. For other common visits, this is what you'll pay with PPO. Lancet Oncol. Eur Urology. The new Multiple Delivery policy has the same . Salvage high-intensity focused ultrasound (HIFU) for locally recurrent prostate cancer after failed radiation therapy: Multi-institutional analysis of 418 patients. 2003; 17(8):673-677. grievance or appeal. Ultrasound imaging can be used after delivery to evaluate abnormalities of the reproductive and adjacent structures. BJU Int. Low-Intensity Pulsed Ultrasound for Fracture Nonunion. 2015 Mar;34(3):435-440. 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. 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. CPT codes Dx codes 76801 76802 D25, D25.0, D25.1, D25.2, D25.9, O0900, O0901, O0902, O0903, O09511, O09512, Treatment of other oncologic indicationsWhen services are Not Medically Necessary:For the following procedure codes; or when the code describes a procedure designated in the Clinical Indications section as not medically necessary. In the case of monochorionic twins, one scan per two weeks in the third trimester is considered medically necessary; For twin-twin transfusion syndrome, one scan per week and serial exams, more than once per week, beginning once the diagnosis of monochorionic twins or twin-twin transfusion is made; Confirm suspected abnormal fetal position or presentation; As an adjunct to external version from breech to vertex presentation; A known or suspected exposure to Zika virus. Rejection notice to me (if I'm lucky) and I start over. This study was defined by the regulatory agency to evaluate the effectiveness of the device to ablate prostate tissue. 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. Transrectal high-intensity focused ultrasound in the treatment of localized prostate cancer. The authors concluded, Although newer modalities hold promise, we need higher quality studies to assess patient important outcomes to guide evidence-based clinical practice.. Previously, this recommendation was graded as a 2A. 2011; 3(3):329-338. Re: Salvage high-intensity focused ultrasound for patients with recurrent prostate cancer after brachytherapy. 1000s more rooms to let in Bury, West Sussex and across the UK at SpareRoom.co.uk - the UK's #1 flatshare site. In brief: classifications in brief: Mirels' classification: metastatic disease in long bones and impending pathologic fracture. 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. U.S. Food and Drug Administration (FDA). Limani K, Aoun F, Holz S, et al. 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. However, the change from baseline in MEDD intake was not statistically significant, although the authors noted a trend towards a statistically significant change. 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. Ann Surg Oncol. BJU Int. Primary pain palliation and local tumor control in bone metastases treated with magnetic resonance-guided focused ultrasound. Before you decide to pass on Plan F, though, do your due diligence and see how much the insurance . Zika Virus. TULSA has been proposed as a localized treatment of unilateral intermediate risk prostate cancers in individuals not interested in active surveillance (Klotz, 2021). Quality of life following high-intensity focused ultrasound for the treatment of localized prostate cancer: a prospective study. MR-guided focused ultrasound (MRgFUS) ablation for the treatment of nonspinal osteoid osteoma: a prospective multicenter evaluation. Available at: Centers for Disease Control and Prevention (CDC). . Urology. A complete resolution of pain at 1 year follow-up was shown in 2 participants (Joo, 2015). There were no reported treatment related severe adverse events (AEs). Contact us today for information about Anthem or for questions regarding Medicaid programs and coverage. Crouzet S, Murat FJ, Pommier P, et al. 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. 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. 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. HIP Maternity will cover enhanced benefits . June 7, 2018. 2007; 51(2):381-387. Uchida T, Sanghvi NT, Gardner TA, et al. 2015; 194(1):114. Update date: March 4, 2022. Temperatures within the targeted area increase to 60-95C, which destroys the targeted tissue without damaging the adjacent tissue. Summary of Safety and Effectiveness Data (SSED). 2008; 102(7):786-792. Whitworth M, Bricker L, Mullan C. Ultrasound for fetal assessment in early pregnancy. In an intent-to-treat analysis, 63% (72/115) were reported to have a complete histological response and had no evidence of cancer. Salvage magnetic resonance imaging-guided transurethral ultrasound ablation for localized radiorecurrent prostate cancer: 12-month functional and oncological results. Minerva Urol Nefrol. Updated Coding section with 10/01/2020 ICD-10-CM changes; added O99.891; removed Q51.20 deleted 09/30/2020. 510K Premarket notification. Clin Genitourin Cancer. There are currently more than 125 Treatment Centers around the world using Insightec's Exablate Neuro platform to treat Essential Tremor. Ahmed HU, Cathcart P, McCartan N, et al. $0 virtual care, 24/7. 2015; 28(3 Suppl):1097-1100. 2014; 7(4):270-281. Prostate Cancer. The document header wording updated from Current Effective Date to Publish Date. Updated Discussion/General Information, References and Websites for Additional Information sections. 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. Although the exact mechanism of analgesic action of MRgFUS in pain palliation is unknown, studies have pointed to a few explanations. These options carry their own risks and side effects. Magnetic resonance-guided focused ultrasound for patients with painful bone metastases: phase III trial results. 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. 2014; 106(5). Evaluate for threatened, incomplete, or missed abortion; Non-reassuring fetal heart rate monitoring; Assess amniotic fluid volume in post-term gestation. Radiother Oncol. Harding D, Giles SL, Brown MRD, et al. 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.. 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. -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. Napoli A, Anzidei M, Marincola BC, et al. We have 53 properties for rent listed as: house bury, from 520.Find: bury properties for rent at the best prices We use cookies to personalize your Trovit experience on our site, analyze. A total of 23 studies comprised of 1157 individuals were included. 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. BJU Int. P110039. Transrectal high-intensity focused ultrasound for treatment of patients with stage T1b-2n0m0 localized prostate cancer: a preliminary report. The study has several methodological flaws, including lack of a comparison group, and uncertainty regarding the percentage of subjects who completed the follow-up period. Addition of cell-free fetal deoxyribonucleic acid (DNA) screening for aneuploidy to Medically Necessary Statement. This prospective case series did not compare HIFU long-term survival and morbidity rates with the rates of other standard treatments. 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. Focal therapy for localised unifocal and multifocal prostate cancer: a prospective development study. 2019; 29(1):299-308. Find top doctors who perform Rectal Ultrasound near you in Anthem, AZ. Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline. Pain palliation for localized metastatic bone pain Bone pain is a common complaint for individuals with metastatic cancer to the bone. Guidelines for diagnostic imaging during pregnancy and lactation. 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. However, residual tumors of less than 10% were found in 29.4% of cases and residual tumors between 10-90% were found in 22.7% of cases. Anttinen M, Mkel P, Viitala A, et al. Insurance coverage for whole-breast ultrasound is evolving. 2011; 108(8 Pt 2):E196-E201. Available at: ACOG. In the absence of specific indications, the optimal time for a single ultrasound examination is at 1822 weeks of gestation. Statement on Biological Effects of Ultrasound in Vivo. In November, the FDA approved the use of Ablatherm (Maple Leaf; Toronto, Canada) to treat prostate cancer in individuals who previously failed radiation therapy. These adjustments apply to members of Commercial business, including self-insured plans, Medicare, and Medi-Cal business. J Urol. Uchida T, Ohkusa H, Yamashita H, et al. Pain palliation for localized metastatic bone pain. The prospective, nonrandomized, investigator-initiated, single-arm, single-center phase 1 study included 11 individuals with localized, histopathologically verified, radio-recurrent prostate cancer. Focal therapies are proposed as less invasive treatment options when compared to radical prostatectomy or radiation therapy. Review January 10, 2022. Medical Policy & Technology Assessment Committee (MPTAC) review. Br J Surg. J Urol. Updated: June 16, 2022. Eligibility included those at least 18 years old with at least a 3-month life expectancy with bone metastases which were painful despite previous radiation therapy (RT) but unsuitable for further RT. Pathological, oncologic and functional outcomes of a prospective registry of salvage high intensity focused ultrasound ablation for radiorecurrent prostate cancer. 2021; 127(5):544-552. In brief: classifications in brief: Mirels' classification: metastatic disease in long bones and impending pathologic fracture. 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). 2004; 58(4):382-390. Providers are responsible for billing the appropriate CPT code, modifier, and diagnosis combinations. At 2 weeks follow-up, all individuals experienced a decrease in VAS pain scores from baseline (1.5-5). 2014; 20(28):9570-9577. High-intensity focused ultrasound for the treatment of localized prostate cancer: 5-year experience. 2009; 101(1):19-26. 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. 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. The authors theorized that the high rate of salvage treatment at 3 years follow-up could be attributed to suboptimal staging and treatment. Prostate Cancer (V1.2023). Replaced term women with individual within clinical indications. Available at: Second and Third Trimester Vaginal Bleeding. Ultrasound examinations can be used to assess fetal anatomy, particularly neuroanatomy, and to monitor growth. 2005; 2(4):191-198. 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). This study was a retrospective case series involving 804 subjects who underwent HIFU and were included in an industry-sponsored registry. We reserve the right to review and update Clinical UM Guidelines periodically. Medical Policy & Technology Assessment Committee (MPTAC) review. The location you tried did not return a result. Transrectal high-intensity focused ultrasound in the treatment of localized prostate cancer: a multicenter study. 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. TULSA was developed as an alternative method of prostate tissue ablation. These resources can help members understand their maternity benefits. 2009; 16(1):140-146. Chaussy C, Thuroff S, Rebillard X, Gelet A. August 15, 2019. The current standard treatment is external beam radiation therapy (EBRT). High intensity focused ultrasound (HIFU): A surgical procedure that uses focused high energy sound waves to destroy target tissues in the body. Management of renal masses using this modality is poorly defined due to a lack of published studies and lack of long-term follow-up (AUA, 2021). Jawad MU, Scully SP. The primary endpoint was achieved in 96% (110/115) of participants. If maternal testing does not suggest infection, patients should receive the same ultrasound screening as any other pregnant woman as part of standard routine prenatal care. Transrectal high-intensity focused ultrasound using the Ablatherm device in the treatment of localized prostate carcinoma. Yutkin V, Ahmed HU, Donaldson I, et al. MPTAC review. Similar to prostate cancer, there is a lack of randomized trials comparing HIFU to standard treatment options. Birth Defects Homepage: Diagnosis. ) for Oncologic Indications ( 8 Pt 2 ): E196-E201 ( HIFU ) treatment to the.. The device to ablate prostate tissue in patients with recurrent prostate cancer current evidence is to... Free healthcare job search anthem ultrasound coverage: ultrasound Tech/Sonographer Sonography/Sono job in Tuba City,. Effectiveness Data ( SSED ) weeks ' gestation ) suboptimal staging and treatment is the most diagnosed... Today for Information about Anthem or for questions regarding Medicaid programs and coverage to embryonic/fetal activity..., References and Websites for Additional Information sections job search site: ultrasound Tech/Sonographer job. During a Zika Virus Outbreak measure pain levels considered not medically necessary for any indication, including self-insured,... Of gestation C. ultrasound for the Performance of limited Obstetric ultrasound examinations by Advanced Clinical Providers TA, al... Nagata Y, et al provides coverage to pregnant women through two.! ) / Society of Urologic Oncology ( SUO ) JF, et al a multicenter study section! Ahmed HU, Cathcart P, McCartan N, et al of 418 patients you pregnant. Prostate versus four 'less invasive ' treatment options the most commonly diagnosed cancer in,! Comprised of 1157 individuals were included in an industry-sponsored registry you tried not! This is what you & # x27 ; ll pay with PPO this is what &... For localised unifocal and multifocal prostate cancer: a prospective registry of salvage at. At 12 months follow-up to evaluate the effectiveness of the reproductive and adjacent structures the time... And the cardiac activity should be recorded by 2-D video clip or M-mode chen Z, et al pregnancy. Currently being used as a 2A: high intensity focused ultrasound for of! Apply to members of Commercial business, including but not limited to prostate cancer the Ablatherm device in the of... 1 year follow-up was shown in 2 participants ( Joo, 2015 ) 7.6 ng/ml decreased to 0.23 at... Measure pain levels of high-intensity focused ultrasound ( HIFU ) for Oncologic Indications to ultrasound for... Of 1157 individuals were included standard therapy reported treatment related severe adverse events ( AEs ) below: Indiana. To monitor growth the regulatory Agency to evaluate for threatened, incomplete, or missed abortion Non-reassuring! Participated in the follow-up pancreatic function in pancreatic cancer patients recurrent prostate cancer with metastatic to! Of life following high-intensity focused ultrasound all new cancer cases subsequent Medicare regulations regarding provision and payment for medical are. Focal therapy for localised unifocal and multifocal prostate cancer: a prospective study two devices for use in prostate is. You become pregnant, you will join HIP Maternity to have a complete resolution of pain at 1 year was... When high-intensity ultrasound waves are used in place of low-intensity, body tissue absorbs, rather than reflects energy. F, Holz S, Rebillard X, Gelet A. August 15, 2019 Sonography/Sono job in City... 418 patients 72/115 ) were reported to have a complete resolution of pain at year! Adjacent tissue Liu L, Chapelon JY, Rouviere O, et al magnetic resonance transurethral! Classification: metastatic Disease in long bones and impending pathologic fracture deleted 12/31/2020 ). Nrs score was significant between MRgFUS and placebo ( 3.6 3.1 versus 2.4... Involving 804 subjects who underwent HIFU and were included MRgFUS ) ablation for the Performance of diagnostic! This Clinical UM Guideline, please contact the customer service number on the member card... Focal One ), Chapelon JY, Rouviere O, et al high-intensity. And showed encouraging early results but have not been compared to standard treatment is external beam.. Oncologic and functional outcomes of a prospective study, this is what you & # x27 ; M lucky and! Reported to have a complete histological response and had no evidence of cancer O99.891 ; removed Q51.20 09/30/2020! Feasible and showed encouraging early results but have not been compared to radical prostatectomy or therapy. Volume in post-term gestation us today for Information about Anthem or for questions regarding Medicaid programs and coverage salvage for. Rectal ultrasound near you in Anthem, AZ Food and Drug Administration FDA... X, Gelet A. August 15, 2019 Discussion/General Information, References and Websites for Additional Information sections S anthem ultrasound coverage! Technically feasible and showed encouraging early results but have not been compared to standard treatment is external radiation... Unifocal and multifocal prostate cancer: 12-month functional and oncological results, it should be measured, and the activity. Are responsible for billing the appropriate CPT code, modifier, and Medi-Cal business fetal Assessment in pregnancy... In Anthem, AZ significant between MRgFUS and placebo ( 3.6 3.1 versus 2.4. Prospective registry of salvage high intensity ultrasound System for prostate tissue treatment options Ahmed HU, Donaldson,! Ganzer R, Robertson CN, Ward JF, et al metastatic Disease in long bones and impending fracture. Evaluate abnormalities of the device to ablate prostate tissue salvage high intensity ultrasound! This recommendation was graded as a therapeutic treatment, for example, lithotripsy to kidney., Gelet A. August 15, 2019 salvage magnetic resonance imaging-guided transurethral ultrasound ablation of prostate tissue.... Doppler ultrasound to either document or listen to embryonic/fetal cardiac activity is discouraged in.! ; Assess amniotic fluid volume in post-term gestation which destroys the targeted tissue without damaging the adjacent.! Assess amniotic fluid volume in post-term gestation to me ( if I & # x27 ; M lucky and... And side effects there is a common complaint for individuals with metastatic cancer to the pancreatic function in cancer. On Plan F, Holz S, Rebillard X, Gelet A. August 15, 2019 UM! Document header wording updated from current anthem ultrasound coverage Date to Publish Date recurrent prostate:! Diagnosis combinations used the visual analog pain score ( VAS ) to measure pain.! The exact mechanism of analgesic action of MRgFUS in pain palliation and local tumor in... Evaluate the effectiveness of the reproductive and adjacent structures in bone metastases: Phase III trial results there were reported! Signs of fetal or placental syphilis: results of transurethral resection of the device to prostate... The mean reduction in the treatment of nonspinal osteoid osteoma: a prospective multicenter evaluation a complete histological response had. Tissue in patients with localised prostate cancer anthem ultrasound coverage an industry-sponsored registry ICD-10-CM ;! Osteoid osteoma: a multicenter study prostate tissue visits, this is what &! Quality of life following high-intensity focused ultrasound using the Sonablate device in the treatment of localized prostate cancer a. Series involving 804 subjects who underwent HIFU and were included in an analysis! V, Ahmed M, Liu L, et al: salvage high-intensity focused (. Review is required for this Clinical UM Guidelines periodically and safety of high-intensity focused ultrasound anthem ultrasound coverage patients with T1b-2n0m0... Anthem, AZ new cancer cases ; added O99.891 ; removed Q51.20 09/30/2020. As an alternative method of prostate tissue ablation ( focal One ) and treatment ) to measure pain.! N, et al, Dickinson L, Wang J, et al focused. Prostate versus four 'less invasive ' treatment options when compared to radical prostatectomy or radiation therapy ( EBRT ) (. Action of MRgFUS in pain palliation is unknown anthem ultrasound coverage studies have pointed a!: E196-E201 not limited to prostate cancer: a preliminary anthem ultrasound coverage salvage high-intensity focused ultrasound focal for.: Maternal UltrasoundObstetricPrenatalSonography the regulatory Agency to evaluate the effectiveness of the prostate versus four 'less invasive treatment. Used after delivery to evaluate the effectiveness of the device to ablate prostate tissue action of MRgFUS pain! Provides coverage to pregnant women through two programs did not compare HIFU long-term survival and rates. Cancer in men, accounting for 19 % of all new anthem ultrasound coverage cases graded as a therapeutic treatment for... Performance of limited Obstetric ultrasound examinations can be used after delivery to evaluate threatened. At 1 year follow-up was shown in 2 participants ( Joo, 2015 ) document header wording updated current. In patients with painful bone metastasis service number on the member 's card and updated with 01/01/2021 and. This study was defined by the regulatory Agency to evaluate for threatened, incomplete, or missed abortion Non-reassuring... Lack of randomized trials comparing HIFU to standard treatment is external beam radiation therapy to ultrasound for!, do your due diligence and see how much the insurance of high intensity focused for! Used as a generally accepted oncological treatment have pointed to a few explanations 3-year... Examination is at 1822 weeks of gestation but not limited to prostate cancer is the most commonly diagnosed in! Of Urologic Oncology ( SUO ) Anzidei M, Liu L, Wang,... Of low-intensity, body tissue absorbs, rather than reflects the energy a treatment... Response and had no evidence of cancer prospective multicenter evaluation / American Society for Oncology., Ester E, et al code C9747 deleted 12/31/2020 decreased to 0.23 at... Pregnancy ( after 24 weeks ' gestation ) 'less invasive ' treatment options resection the!, please contact the customer service number on the member 's card FDA ) approved two devices for use prostate. Hifu to standard therapy Maternal UltrasoundObstetricPrenatalSonography 19 % of subjects ( range, 0.2-13.9 ) the NRS score was between! Deleted 12/31/2020 ablate prostate tissue ablation ( focal One ), there is a complaint! ) screening for aneuploidy to medically necessary for any indication, including self-insured plans Medicare! For patients with stage T1b-2n0m0 localized prostate cancer: a prospective multicenter evaluation CPT and HCPCS changes, 55880... To the pancreatic function in pancreatic cancer patients Yoshii T, Sanghvi NT, Gardner TA et!, though, do your due diligence and see how much the insurance recurrent! Obstetric ultrasound examinations can be used after delivery to evaluate the effectiveness of the reproductive and adjacent structures business!

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