However, EBRT has been shown to be ineffective in approximately 20-30% of cases and pain recurs in 27% of the treated population (Liberman, 2009). 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). The available evidence does not support that the use of TULSA is clinically appropriate and an effective therapy compared to the standard treatments. The use of HIFU in the setting of breast cancer treatment may not allow for an adequate collection of tumor specimens to evaluate the tumor histopathology. Salvage high-intensity focused ultrasound for patients with recurrent prostate cancer after brachytherapy. 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). 2010; 468(10):2825-2827. Magnetic resonance-guided focused ultrasound for patients with painful bone metastases: phase III trial results. Kenkhuis MJA, Bakker M, Bardi F, ET AL. ACOG Practice Bulletin Number 183, October 2017. close combat footage enemy visible bungee fitness dickson tn Tue, Oct 18 2022 Accessed on October 20, 2022. Elterman D, Li W, Hatiboglu G, et al. Urology. Updated Coding, Description, Discussion/General Information, and References. July 23, 2021. Eur Urol. 2014; 65(5):907-914. The current standard treatment is external beam radiation therapy (EBRT). 2015 Mar;34(3):435-440. Pregnant Women. Updated Discussion, References and Websites for Additional Information sections. 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. Shah TT, Peters M, Kanthabalan A, et al. According to the FDA labeling, a nonunion is considered to be established when the fracture site shows no visibly progressive signs of healing. 2005; 19(6):693-701. Effects of high-intensity focused ultrasound for treatment of abdominal lymph node metastasis from gastric cancer. Poissonnier L, Chapelon JY, Rouviere O, et al. Updated References. J Urol. Urology. 2006b; 97(1):56-61. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Peek and associates (2015) conducted a systematic review of the use of HIFU in breast cancer. The new Multiple Delivery policy has the same . Updated Coding section with 10/01/2020 ICD-10-CM changes; added O99.891; removed Q51.20 deleted 09/30/2020. The wait is over. 2015; 56(2):503-509. Non-Contact Ultrasound Treatment for Wounds; Non-Oncologic Uses of Rituximab (Rituxan) Nutritional Treatment of Childhood Medical Conditions; Ophthalmologic Techniques for Evaluating Glaucoma; Optical Diagnostic Devices for Evaluating Skin Lesions Suspected of Malignancy ; Oral Lesion Identification System (ViziLite, Velscope) 2017; 197(1):97-102. ACR Appropriateness Criteria. These resources can help members understand their maternity benefits. 2011; 3(3):329-338. Post-treatment biopsies were available in 77% of subjects. When services are Not Medically Necessary:For the procedure and diagnosis codes listed above when criteria are not met or for all other diagnoses not listed; or when the code describes a procedure or situation designated in the Clinical Indications section as not medically necessary. Prostate Cancer Prostatic Dis. 2004; 7(4):289-294. AIUM Practice Parameter for the Performance of Detailed Second- and Third-Trimester Diagnostic Obstetric Ultrasound Examinations. The baseline median PSA of 7.6 ng/ml decreased to 0.23 ng/ml at 12 months follow-up. MPTAC review. 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. We reserve the right to review and update Clinical UM Guidelines periodically. Eur Urol. J Urol. There were no reported treatment related severe adverse events (AEs). Reaffirmed October 2021. Napoli A, Anzidei M, Marincola BC, et al. Updated Coding section with 10/01/2018 ICD-10-CM diagnosis code changes; added Q51.20-Q51.28, Z20.821. The maternal cervix and adnexa should be examined. 2018. MPTAC review. 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). MPTAC review. Schatzl G, Madersbacher S, Djavan B, et al. Routine Tests During Pregnancy. 2014; 84(5):1157-1162. Guidelines for diagnostic imaging during pregnancy and lactation. 2017. Bricker L, Medley N, Pratt JJ. Urology. Focal therapy for localised unifocal and multifocal prostate cancer: a prospective development study. 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. Ultrasound is currently being used as a therapeutic treatment, for example, lithotripsy to disintegrate kidney stones. These adjustments apply to members of Commercial business, including self-insured plans, Medicare, and Medi-Cal business. TULSA is considered not medically necessary for any indication, including but not limited to prostate cancer. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. Int J Urol. Rebillard X, Gelet A, Davin JL, et al. Nair SM, Hatiboglu G, Relle J, et al. Control of prostate cancer by transrectal HIFU in 227 patients. TULSA has been proposed as a localized treatment of unilateral intermediate risk prostate cancers in individuals not interested in active surveillance (Klotz, 2021). Magnetic resonance imaging-guided transurethral ultrasound ablation of prostate tissue in patients with localized prostate cancer: a prospective Phase 1 clinical trial. Birth Defects Homepage: Diagnosis. 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 . Blana A, Murat FJ, Walter B, et al. 2011; 108(8 Pt 2):E196-E201. MR-guided focused ultrasound (MRgFUS) ablation for the treatment of nonspinal osteoid osteoma: a prospective multicenter evaluation. This will stop any POWER account payment or copays while you are pregnant, and for 12 months after giving birth. 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. 2005; 51(10):651-658. Bone pain is a common complaint for individuals with metastatic cancer to the bone. Ultrasound examinations can be used to assess fetal anatomy, particularly neuroanatomy, and to monitor growth. Hemi salvage high-intensity focused ultrasound (HIFU) in unilateral radiorecurrent prostate cancer: a prospective two-centre study. MPTAC review. Jawad MU, Scully SP. The primary endpoint was the proportion of individuals who achieved a 75% or greater reduction in PSA at 12 months post-procedure. Comprehensive medical coverage that covers many common services at no cost or for a low copay. Yonsei Med J. 2010; 468(10):2825-2827. Zika virus was first reported in South America in May 2015 and since that time has now appeared in the United States. Available at: Antepartum Fetal surveillance. Find top doctors who perform Rectal Ultrasound near you in Anthem, AZ. Geiger D, Napoli A, Conchiglia A, et al. 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. There is insufficient evidence to draw conclusions about the effect of HIFU on urinary incontinence, erectile dysfunction or fecal incontinence when compared to radical prostatectomy. In a phase 1, single-arm, prospective study, Chin and colleagues (2016) evaluated the safety and feasibility of MRI guided TULSA. In a prospective, non-randomized single arm trial, MRgFUS was used on 5 individuals with painful bone metastatic lesions with a pain rating of 4 or higher. 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. Government Agency, Medical Society, and Other Authoritative Publications: Maternal UltrasoundObstetricPrenatalSonography. MPTAC review. Influence of high intensity focused ultrasound (HIFU) treatment to the pancreatic function in pancreatic cancer patients. Due to variances in utilization patterns, each plan may choose whether to adopt a particular Clinical UM Guideline. Assessment of chorionicity is most accurate early in pregnancy and, because of the increased rate of complications associated with monochorionicity, determination of chorionicity by the late first trimester or early second trimester is important for counseling and caring for women with multifetal pregnancies. It is likely that both of these treatment effects contribute to pain relief. Crouzet S, Blana A, Murat FJ, et al. There are concerns about inconsistent treatment coverage within renal masses resulting in incomplete ablation. First clinical experience of intra-operative high intensity focused ultrasound in patients with colorectal liver metastases: a phase I-IIa study. High-intensity focused ultrasound and localized prostate cancer: efficacy results from the European multicentric study. The overall survival (OS) rate was 80%, the progression-free survival (PFS) rate was 94%, and the disease-specific survival rate was 97%. Urol Oncol. The current evidence does not show that clinical outcomes of those undergoing TULSA is similar to those undergoing established alternatives. Updated Coding section; added ICD-10-CM code ranges O98.111-O98.119, O99.310-O99.313, O99.320-O99.323, O99.330-O99.333. The authors reported that salvage TULSA was technically feasible and showed encouraging early results but have not been compared to standard therapy. Rooms for rent in Bury flat and house shares - 3 currently available. Twelve-month prostate volume reduction after MRI-guided transurethral ultrasound ablation of the prostate. Uchida T, Tomonaga T, Kim H, et al. When services are Medically Necessary for routine anatomy screen and dating when criteria are met: Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks, 0 days), transabdominal approach; single or first gestation/each additional gestation [includes codes 76801, 76802], Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> 14 weeks 0 days), transabdominal approach; single or first gestation/each additional gestation [includes codes 76805, 76810], Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation/each additional gestation [includes codes 76811, 76812], Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses, Ultrasound, pregnant uterus, real time with image documentation, follow-up (eg, re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ system(s) suspected or confirmed to be abnormal on a previous scan), transabdominal approach, per fetus, Ultrasound, pregnant uterus, real time with image documentation, transvaginal. Updated Description, Coding, Discussion and References sections. American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal Fetal Medicine (SMFM). Napoli A, Anzidei M, De Nunzio C, et al. 2021; 35(4):497-505. Br J Surg. Of note, 65.7% (23/35) of individuals in the placebo group did not complete the 3-month follow-up compared to approximately 21% (26/112) of the MRgFUS group. 2015; 2015(7):CD007058. 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: Testing for Zika Virus Infections. TULSA was developed as an alternative method of prostate tissue ablation. Cancer. 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. The most relevant clinical information is obtained when serial exams are done at least three weeks apart, beginning no earlier than 18 weeks gestation. 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. 2007; 51(2):381-387. 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). In February 2000, the labeled indication for the SAFHS (now known as the Exogen device) (Smith and Nephew, Inc., Biologics & Spine, Durham, NC) was expanded to include the treatment of established fracture nonunions, excluding the skull and vertebra. Transrectal high-intensity focused ultrasound using the Ablatherm device in the treatment of localized prostate carcinoma. Although the exact mechanism of analgesic action of MRgFUS in pain palliation is unknown, studies have pointed to a few explanations. When services are Not Medically Necessary:For the procedure and diagnosis codes listed above when criteria are not met. September 15, 2017. Alternatively, the reduced tumor mass caused by thermal ablation may have an analgesic effect. Federal and State law, as well as contract language, and Medical Policy take precedence over Clinical UM Guidelines. Free healthcare job search site: Ultrasound Tech/Sonographer Sonography/Sono job in Tuba City Arizona, USA. 2017; 119(6):896-904. Uchida T, Ohkusa H, Nagata Y, et al. Palliative treatment: Treatment given for relief of symptoms and pain rather than attempting to cure. This study was a retrospective case series involving 804 subjects who underwent HIFU and were included in an industry-sponsored registry. Available at: Limited obstetrical ultrasound examination. * Make sure your health is protected with an Individual and Family plan you can count on in 2023. One ultrasound of a pregnant uterus per member, per routine course of care; Estimate gestational age for individuals with uncertain clinical dates. Revised June 27, 2022. 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. August 15, 2019. AIUM practice guideline for the performance of obstetric ultrasound examinations. Improved outcomes with advancements in high intensity focused ultrasound devices for the treatment of localized prostate cancer. Pain palliation in patients with bone metastases using magnetic resonance-guided focused ultrasound with conformal bone system: a preliminary report. 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%). Addition of cell-free fetal deoxyribonucleic acid (DNA) screening for aneuploidy to Medically Necessary Statement. Li CC, Wang YQ, Li YP, Li XL. The updated file enables providers to separately bill for the professional component (26) and the technical component (TC). Available at: Dahm P, Brasure M, Ester E, et al. We reserve the right to review and update Clinical UM Guidelines periodically. At various gestational ages, ultrasound examination is an accurate method of determining gestational age, fetal number, viability, and placental location, and it is recommended for all pregnant patients. Available at. First analysis of the long-term results with transrectal HIFU in patients with localised prostate cancer. 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 . 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. The authors noted that incomplete tumor ablation could be related to poor accuracy in determining the target area or movement during the procedure. 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. Whole-gland salvage high-intensity focused ultrasound therapy for localized prostate cancer recurrence after external beam radiation therapy. 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. 2005; 2(4):191-198. Gelet A, Chapelon JY, Bouvier R, et al. Kaur A, Kaur A. Transvaginal ultrasonography in first trimester of pregnancy and its comparison with transabdominal ultrasonography. Salvage radical prostatectomy following primary high intensity focused ultrasound for treatment of prostate cancer. Eur Urol. PSA nadir as a predictive factor for biochemical disease-free survival and overall survival following whole-gland salvage HIFU following radiotherapy failure. 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). The sound wave echoes are recorded and displayed as a real-time visual image. grievance or appeal. High Intensity Ultrasound System For Prostate Tissue Ablation (Ablatherm). BJU Int. The whole-breast ultrasound is designed to improve the detection rate of breast cancer in women with dense breasts, beyond what a mammogram alone can find. 2020; 22:79-87. BJU Int. There are currently two ultrasound ablative techniques. 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. 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 document header wording updated from Current Effective Date to Publish Date. Updated Discussion/General Information, References and Websites for Additional Information sections. You bet! 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. AIUM Practice Parameter for the Performance of Limited Obstetric Ultrasound Examinations by Advanced Clinical Providers. 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. Zika Virus. High intensity focused ultrasound ablation for patients with inoperable liver cancer. . Following treatment, no residual tumor was found in 46.2% of cases. 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. Ultrasound, the use of low-intensity sound waves to produce images, is an established diagnostic tool. 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. Bone metastases are common in breast and prostate cancer (Liberman, 2009). 2016; 47(4):530-532. Harding D, Giles SL, Brown MRD, et al. Magnetic resonance imaging-guided transurethral ultrasound ablation in patients with localised prostate cancer: 3-year outcomes of a prospective Phase I study. You can learn about each program by clicking on the links below: Healthy Indiana Plan. CPT codes Dx codes 76801 76802 D25, D25.0, D25.1, D25.2, D25.9, O0900, O0901, O0902, O0903, O09511, O09512, HIFU has been proposed as a treatment for multiple oncologic conditions. 2015; 10(2):e0118212. Focal salvage high-intensity focused ultrasound in radiorecurrent prostate cancer. Safety trial of high-intensity focused ultrasound therapy for pancreatic cancer. This study was defined by the regulatory agency to evaluate the effectiveness of the device to ablate prostate tissue. American College of Obstetricians and Gynecologists (ACOG). J Urol. Similar to prostate cancer, there is a lack of randomized trials comparing HIFU to standard treatment options. Low-Intensity Pulsed Ultrasound for Fracture Nonunion. High-intensity focused ultrasound (HIFU) followed after one to two weeks by radical retropubic prostatectomy: results of a prospective study. For relief of symptoms and pain rather than attempting to cure, Rouviere O, et al clip or.... Factor for biochemical disease-free survival and overall survival following whole-gland salvage HIFU following radiotherapy failure available evidence does not that! 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And Family plan you can learn about each program by clicking on the links below Healthy. Ultrasound and localized prostate cancer: a preliminary report links below: Healthy Indiana plan system: prospective... ) treatment to the standard treatments, added 55880 to replace NOC code ; code C9747 deleted 12/31/2020, S... Abdominal lymph node metastasis from gastric cancer et al patients with recurrent prostate.. Header wording updated from current effective Date to Publish Date subsequent Medicare regulations regarding provision and for! Cost or for a low copay palliation in patients with recurrent prostate cancer events! Abdominal lymph node metastasis from gastric cancer the effectiveness of the prostate there is a complaint. Resources can help members understand their maternity benefits of high intensity ultrasound system for prostate tissue ablation ( Ablatherm.. 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