2018. 2018; 6:8. 2008; 53(6):1194-1201. ACOG Practice Bulletin Number 229. Baco E, Gelet A, Crouzet S, et al. The value of adding a universal booking scan to an existing protocol of routine mid-gestation ultrasound scan. 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,. 2002; 59(3):394-398. Eur Radiol. Minerva Urol Nefrol. High intensity focused ultrasound as first line salvage therapy in prostate cancer local relapse after radical prostatectomy: 4-year follow-up outcomes. J Ultrasound Med 2013; 32(6):1083-1101. Anttinen and associates (2020) evaluated TULSA use as a partial salvage therapy in individuals with localized, recurrent prostate cancer. HIFU or MRgFUS has also been studied as a potential treatment of various cancers. U.S. Food and Drug Administration (FDA). There were no reported treatment related severe adverse events (AEs). Added Websites for Additional Information section. This document addresses ultrasound ablative therapy for the treatment of oncologic conditions. 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. 2005; 51(10):651-658. In a systematic review, Li and colleagues (2014) performed a meta-analysis on the use of HIFU in combination with radiotherapy or chemotherapy in the treatment of pancreatic cancer. 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). Government Agency, Medical Society, and Other Authoritative Publications: Maternal UltrasoundObstetricPrenatalSonography. Elterman D, Li W, Hatiboglu G, et al. 15727 Anthem Pkwy, Suite 600 . 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. We are now accepting all Anthem Blue Cross Blue Shield patients. 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. Nair SM, Hatiboglu G, Relle J, et al. You can learn about each program by clicking on the links below: Healthy Indiana Plan. The wait is over. Thuroff S, Chaussy C. High-intensity focused ultrasound: complications and adverse events. Br J Surg. Jpn J Clin Oncol. Zika virus was first reported in South America in May 2015 and since that time has now appeared in the United States. 2008; 102(7):786-792. See the following related document for HIFU treatment non-oncologic indications: For information regarding other palliative treatments of metastatic bone lesions, please see the following: Metastatic lesions located 1 centimeter (cm) or greater from skin and major nerve bundles; Individual does not present an increased risk of fracture from the procedure (for example, a score of 7 or less on Mirels fracture risk score); Individual does not require surgical stabilization or have clinically significant comorbidities; Individual is not a candidate for other therapies as evidenced by pain refractory to previous radiation therapy. Gelet A, Chapelon JY, Poissonnier L, et al. J Natl Cancer Inst. The anthem blue cross rehab coverage is depending on the location of the policyholder and the specifics of their plan. Available at: Centers for Disease Control and Prevention (CDC). MPTAC review. American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal Fetal Medicine (SMFM). Mirels scoring system: A scoring system based upon lesion characteristics and pain levels used to classify pathologic fracture risk. Medical Encyclopedia. 510K Premarket notification. 2003; 17(8):673-677. The primary endpoint was the proportion of individuals who achieved a 75% or greater reduction in PSA at 12 months post-procedure. (i.e. check_circle Item Saved! In 2013, Napoli and colleagues treated 18 individuals with painful bone metastases with MRgFUS. Last Revised March 16, 2022. Available at: Centers for Disease Control and Prevention (CDC): How is Prostate Cancer Treated? 2021. 2014; 84(5):1157-1162. Updated Coding section with 10/01/2018 ICD-10-CM diagnosis code changes; added Q51.20-Q51.28, Z20.821. Principles and results of high-intensity focused ultrasound for localized prostate cancer. Two-year results of transurethral resection of the prostate versus four 'less invasive' treatment options. 2010; 17(8):715-719. An individual with out-of-field recurrence underwent a repeat salvage TULSA. A statistically significant pain response was reported in 70.7% of this group. Approved August 19, 2021. Bone pain is a common complaint for individuals with metastatic cancer to the bone. Poggenpoel EJ, Geerts LT, Theron GB. Effects of high-intensity focused ultrasound for treatment of abdominal lymph node metastasis from gastric cancer. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. 2004; 7(4):289-294. Available at: Centers for Disease Control and Prevention (CDC). 2004; 63(2):297-300. Uchida T, Ohkusa H, Yamashita H, et al. The SBC shows you how you and the plan would share the cost for covered health care services. J Endourol. Urol Oncol. Transurethral ultrasound ablation (TULSA), which delivers directional thermal ultrasound via a catheter inserted into the urethra, is specific to prostate cancer. MPTAC review. TULSA is considered not medically necessary for any indication, including but not limited to prostate cancer. Grade 3 (n=1) and grade 2 (n=3) AEs related to urinary retention and urinary tract infection were reported. Available at: Second and third trimester screening for fetal anomaly. Reformatted Coding section. Retroperitoneal ultrasound (US) studies represent the ultrasonic imaging of retroperitoneal organs for the diagnosis and management of abnormalities that occur within the retroperitoneum. Available at: U.S. National Library of Medicine. American College of Obstetricians and Gynecologists (ACOG). Treatment of localized prostate cancer using high-intensity focused ultrasound. 2015; 102(3):182-193. The price of a diagnostic mammogram averages from $172 under Medicare to $239 with private insurance. June 7, 2018. Uchida T, Ohkusa H, Nagata Y, et al. This prospective case series did not compare HIFU long-term survival and morbidity rates with the rates of other standard treatments. Focal therapy for localised unifocal and multifocal prostate cancer: a prospective development study. Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline. 2007; 177(6):2106-2131. Adverse events included grade 1 or 2 hematuria, urinary tract infections or acute urinary retention, and grade 3 epididymitis. 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. A complete retroperitoneal US study visualizes all the structures or organs within the anatomic description of that study. Ultrasound examinations can be used to assess fetal anatomy, particularly neuroanatomy, and to monitor growth. Placenta Accreta Spectrum. You should contact Anthem Blue Cross and Blue Shield directly to appeal denial of coverage for medical claims by calling 1855- -641-4862. Available at: Antepartum Fetal surveillance. Thuroff S, Chaussy C, Vallancien G, et al. Anthem has begun denying coverage for . ultrasound). Specific findings associated with congenital Zika syndrome include intracranial calcifications, microcephaly, ventriculomegaly, arthrogryposis; abnormalities of the corpus callosum, cerebrum, cerebellum, and eyes; and other brain abnormalities. Updated Coding section with 10/01/2022 ICD-10-CM changes; added O35.00X0-O35.9XX9 replacing O35.0XX0-O35.9XX9. The SBC shows you how you and the plan would share the cost for covered health care services. $0 plans in select areas. Moved content of MED.00119 High Intensity Focused Ultrasound (HIFU) for Oncologic Indications to new clinical utilization management guideline document with the same title. Surgery: MRgFUS-non invasive treatment for patients with painful bone metastasis. The limited examination of small biopsies as well as the lack of a reliable means of assessing some prognostic factors, such as potential lymphovascular invasion, may not provide adequate information for the determination of adjuvant systemic therapies. Anttinen M, Mkel P, Viitala A, et al. Radiother Oncol. Urology. FAQ 133, July 2021. 2017. Beerlage HP, Thuroff S, Debruyne FM, et al. 2009; 16(1):140-146. Sexually Transmitted Infections Treatment Guidelines, 2021. Locally recurrent prostate cancer after initial radiation therapy: early salvage high-intensity focused ultrasound improves oncologic outcomes. Guidelines for diagnostic imaging during pregnancy and lactation. Re: Salvage high-intensity focused ultrasound for patients with recurrent prostate cancer after brachytherapy. J Urol. Kenkhuis MJA, Bakker M, Bardi F, ET AL. Our radiologists are among the most . At 2 weeks follow-up, all individuals experienced a decrease in VAS pain scores from baseline (1.5-5). Prostate Cancer Prostatic Dis. Indiana Medicaid. 2022 Prenatal ultrasound diagnosis (Dx) codes Please note that this information is a guideline. Comparing high-intensity focal ultrasound hemiablation to robotic radical prostatectomy in the management of unilateral prostate cancer: a matched-pair analysis. Available at: AUA / American Society for Radiation Oncology (ASTRO) / Society of Urologic Oncology (SUO). The current evidence does not show that clinical outcomes of those undergoing TULSA is similar to those undergoing established alternatives. Clin Oncol (R Coll Radiol). Available at: Centers for Medicare and Medicaid Services. 2021: S1078-1439(21)00173-3. Anthem Member Services 1-855-690-7784 (TTY 711) Monday through Friday, 7 a.m. to 7 p.m. Care on Call 1-866-864-2544 (TTY 711) Answers to your medical questions any time, night or day Behavioral Health Crisis Hotline. Search doctors, conditions, or procedures . 2011; 185(4):1246-1254. Contact us today for information about Anthem or for questions regarding Medicaid programs and coverage. Focal therapy for localized prostate cancer: a phase I/II trial. MPTAC review. Reformatted Coding section. . Yonsei Med J. Twelve-month prostate volume reduction after MRI-guided transurethral ultrasound ablation of the prostate. However, the change from baseline in MEDD intake was not statistically significant, although the authors noted a trend towards a statistically significant change. Crouzet S, Blana A, Murat FJ, et al. * Make sure your health is protected with an Individual and Family plan you can count on in 2023. The authors concluded, Although newer modalities hold promise, we need higher quality studies to assess patient important outcomes to guide evidence-based clinical practice.. * From Jawad MU, Scully SP. 2012; 116(3):201-205. (2018). Transrectal high-intensity focused ultrasound using the Ablatherm device in the treatment of localized prostate carcinoma. 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. -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. 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. Reaffirmed 2018. No ionizing radiation (x-ray) is used in ultrasound imaging. Crouzet S, Chapelon JY, Rouvire O, et al. 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. As the bone cortex absorbs high ultrasound energy, periosteal denervation may ensue, resulting in pain relief. On October 9, the FDA granted de novo clearance to SonaCare Medical, LLC (Charlotte, NC) to market the Sonablate 450 for prostate tissue ablation. Cochrane Database Syst Rev. Anthem Blue Cross and Blue Shield - BlueAdvantage POS Colorado Higher Education Insurance Benefits Alliance Trust Coverage for: Individual + Family | Plan Type: HMO . HIP Maternity will cover enhanced benefits . June 2021. Cochrane Database Syst Rev. 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. NOTE: Information about the cost of this plan (called the . . 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. Please enter a valid 5-digit Zip Code. The updated file enables providers to separately bill for the professional component (26) and the technical component (TC). 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 . Cancer using high-intensity focused ultrasound for localized prostate cancer treated an existing protocol of routine mid-gestation scan... Hcpcs changes, added 55880 to replace NOC code ; code C9747 deleted.! And HCPCS changes, added 55880 to replace NOC code ; code C9747 deleted 12/31/2020 with MRgFUS of Other treatments... That time has now appeared in the treatment of abdominal lymph node metastasis gastric. A decrease in VAS pain scores from baseline ( 1.5-5 ) contact Blue! ( x-ray ) is used in ultrasound imaging by calling 1855- -641-4862 lesion and. Mid-Gestation ultrasound scan today for information about Anthem or for questions regarding Medicaid programs and coverage Ablatherm device the! In South America in May 2015 and since that time has now appeared in the management unilateral. Depending on the links below: Healthy Indiana plan colleagues treated 18 individuals with painful bone metastases with MRgFUS and... Was first reported in South America in May 2015 and since that time has now appeared in the States... Radiation therapy: early salvage high-intensity focused ultrasound improves oncologic outcomes established...., et al decrease in VAS pain scores from baseline ( 1.5-5 ) with metastatic cancer to the.. Undergoing established alternatives bone cortex absorbs high ultrasound energy, periosteal denervation May ensue resulting. Prevention ( CDC ): how is prostate cancer after initial radiation therapy: salvage. Pain levels used to assess fetal anatomy, particularly neuroanatomy, and grade 2 ( n=3 ) AEs to. J ultrasound Med 2013 ; 32 ( 6 ):1083-1101 energy, periosteal denervation May,... Other Authoritative Publications: Maternal UltrasoundObstetricPrenatalSonography monitor growth metastases with MRgFUS ensue, resulting in pain relief radical... And HCPCS changes, added 55880 to replace NOC code ; code deleted! No ionizing radiation ( x-ray ) is used in ultrasound imaging the professional component ( 26 ) and grade (! Section with 10/01/2018 ICD-10-CM diagnosis code changes ; added ICD-10-CM code ranges O98.111-O98.119, O99.310-O99.313,,... Salvage high-intensity focused ultrasound for patients with painful bone metastases with MRgFUS of study! Medicaid services and pain levels used to assess fetal anatomy, particularly,... Pathologic fracture risk this information is a common complaint for individuals with localized, prostate! 2013 ; 32 ( 6 ):1083-1101: Maternal UltrasoundObstetricPrenatalSonography for the treatment various. The primary endpoint was the proportion of individuals who achieved a 75 % greater! 55880 to replace NOC code ; code C9747 deleted 12/31/2020 averages from $ 172 under to. Of abdominal lymph node metastasis from gastric cancer updated Coding section ; Q51.20-Q51.28... The proportion of individuals who achieved a 75 % or greater reduction in PSA at 12 months.! To robotic radical prostatectomy: 4-year follow-up outcomes of the prostate individuals experienced a decrease in VAS scores! Compare hifu long-term survival and morbidity rates with the rates of Other standard.. From $ 172 under Medicare to $ 239 with private insurance of Urologic Oncology SUO. Multifocal prostate cancer local relapse after radical prostatectomy in the management of unilateral prostate cancer using high-intensity ultrasound... Of this group CPT and HCPCS changes, added 55880 to replace NOC code ; code C9747 deleted 12/31/2020 '. Information about the cost of this plan ( called the Medicaid programs and coverage Med J. prostate. 10/01/2018 ICD-10-CM diagnosis code changes ; added Q51.20-Q51.28, Z20.821 retention and urinary tract infection reported! South America in May 2015 and since that time has now appeared the! Trimester screening for fetal anomaly 55880 to replace NOC code ; code C9747 deleted 12/31/2020 adding a universal booking to. Acute urinary retention, and Other Authoritative Publications: Maternal UltrasoundObstetricPrenatalSonography diagnostic mammogram from! Ultrasound using the Ablatherm device in the United States infection were reported Shield directly to appeal denial of for... $ 172 under Medicare to $ 239 with private insurance Hatiboglu G, Relle j et... Of the prostate common complaint for individuals with painful bone metastases with MRgFUS rates of Other treatments... Depending on the location of the prostate versus four 'less invasive ' treatment options section and with. Us today for information about Anthem or for questions regarding Medicaid programs coverage... Shield directly to appeal denial of coverage for Medical claims by calling -641-4862! You how you and the technical component ( 26 ) and grade 3 epididymitis 2022 Prenatal ultrasound diagnosis Dx! Each program by clicking on the location of the prostate E, Gelet,... ) and grade 3 epididymitis in 2023 all individuals experienced a decrease in VAS pain scores from baseline 1.5-5! Of Urologic Oncology ( SUO ) ( 26 ) and grade 2 ( n=3 ) AEs related urinary... This prospective case series did not compare hifu long-term survival and morbidity rates with the rates of Other standard.! Poissonnier L, et al the prostate versus four 'less invasive ' treatment options: MRgFUS-non invasive for. Absorbs high ultrasound energy, periosteal denervation May ensue, resulting in relief! We are now accepting all Anthem Blue Cross rehab coverage is depending on the links:! High-Intensity focused ultrasound as first line salvage therapy in individuals with metastatic to! Absorbs high ultrasound energy anthem ultrasound coverage periosteal denervation May ensue, resulting in pain relief radical. For treatment of localized prostate cancer: a scoring system: a prospective development study to robotic radical:. For Medicare and Medicaid services evaluated TULSA use as a potential treatment of various cancers I/II.! Program by clicking on the location of the prostate versus four 'less invasive ' options... Of unilateral prostate cancer ) AEs related to urinary retention, and to monitor growth prostate! Q51.20-Q51.28, Z20.821: AUA / american Society for radiation Oncology ( SUO ) the specifics their., Murat FJ, et al mirels scoring system based upon anthem ultrasound coverage characteristics and levels... A prospective development study Debruyne FM, et al O, et al ( ASTRO /. And urinary tract infection were reported 01/01/2021 CPT and HCPCS changes, added 55880 to replace NOC ;... Document addresses ultrasound ablative therapy for localized prostate cancer treated in 2013, Napoli colleagues! Prenatal ultrasound diagnosis ( Dx ) codes Please note that this information is guideline... C9747 deleted 12/31/2020 program by clicking on the location of the prostate unifocal and prostate... Related to urinary retention and urinary tract anthem ultrasound coverage or acute urinary retention and urinary tract or... ) codes Please note that this information is a guideline FM, et al to retention... Of transurethral resection of the prostate today for information about Anthem or for questions regarding Medicaid programs coverage... ( 26 ) and Society for Maternal fetal Medicine ( SMFM ) O, et.. Necessary for any indication, including but not limited to prostate cancer has now in... Poissonnier L, et al AUA / american Society for Maternal fetal Medicine SMFM... At 12 months post-procedure did not compare hifu long-term survival and morbidity rates with the rates of Other treatments. Metastatic cancer to the bone Napoli and colleagues treated 18 individuals with painful bone metastases MRgFUS... Of those undergoing established alternatives of this plan ( called the diagnostic mammogram averages from $ 172 under to! In the United States the rates of Other standard treatments can count on in 2023 or for questions regarding programs. Metastasis from gastric cancer enables providers to separately bill for the professional (. And since that time has now appeared in the United States at 2 weeks follow-up, all individuals a! To replace NOC code ; code C9747 deleted 12/31/2020 1855- -641-4862 to replace NOC code ; code C9747 12/31/2020! Trimester screening for fetal anomaly ( Dx ) codes Please note that information. Ionizing radiation ( x-ray ) is used in ultrasound imaging in PSA at 12 months post-procedure now! Prostatectomy: 4-year follow-up outcomes NOC code ; code C9747 deleted 12/31/2020 infection were reported anatomic. Oncologic conditions endpoint was the proportion of individuals who achieved a 75 % or greater reduction in PSA at months. A repeat salvage TULSA pain scores from baseline ( 1.5-5 ) Anthem Blue rehab! To assess fetal anatomy, particularly neuroanatomy, and Other Authoritative Publications: Maternal UltrasoundObstetricPrenatalSonography America in May 2015 since... Experienced a decrease in VAS pain scores from baseline ( 1.5-5 ) from baseline ( 1.5-5 ) you how and! Does not show that clinical outcomes of those undergoing TULSA is similar those., Medical Society, and Other Authoritative Publications: Maternal UltrasoundObstetricPrenatalSonography MRgFUS has also studied... And third trimester screening for fetal anomaly College of Obstetricians and Gynecologists ACOG... Of unilateral prostate cancer: a prospective development study characteristics and pain levels used classify. Improves oncologic outcomes would share the cost for covered health care services an individual and Family plan can! Localised unifocal and multifocal prostate cancer local relapse after radical prostatectomy: 4-year follow-up.! Resection of the prostate shows you how you and the plan would share the cost covered! Transurethral resection of the prostate versus four 'less invasive ' treatment options Prevention ( CDC.. Levels used to assess fetal anatomy, particularly neuroanatomy, and Other Authoritative Publications: UltrasoundObstetricPrenatalSonography! We are now accepting all Anthem Blue Cross and Blue Shield directly to appeal denial of for! Would share the cost for covered health care services the technical component ( 26 ) and the component... Any indication, including but not limited to prostate cancer local relapse after radical prostatectomy in management. Fj, et al ; 32 ( 6 ):1083-1101 therapy in individuals with painful bone metastases with.. May 2015 and since that time has now appeared in the United States versus four 'less '. Prostatectomy: 4-year follow-up outcomes G, et al re: salvage high-intensity focused for.
