anthem ultrasound coverage

The use of high intensity focused ultrasound (HIFU) is considered medically necessary for pain palliation in individuals with localized metastatic bone pain when all the following criteria are met: High intensity focused ultrasound (HIFU) is considered not medically necessary when the above criteria are not met and for all other indications, including but not limited to, the treatment of 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. Alldred SK, Takwoingi Y, Guo B, et al. 2014; 65(5):907-914. 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. Updated Discussion, References and Websites for Additional Information sections. Medical Encyclopedia. Renal mass and localized renal cancer: Evaluation, management, and follow-up: AUA guideline. 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). There was 1 in-field and 2 out-of-field recurrences reported at that time. 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. Clin Orthop Relat Res. Salvage high-intensity focused ultrasound (HIFU) for locally recurrent prostate cancer after failed radiation therapy: Multi-institutional analysis of 418 patients. One ultrasound of a pregnant uterus per member, per routine course of care; Estimate gestational age for individuals with uncertain clinical dates. The maternal cervix and adnexa should be examined. Anthem Blue Cross Blue Shield: Health Insurance, Medicare & More Learn more about your coverage options after the Public Health Emergency (PHE) ends. Safety trial of high-intensity focused ultrasound therapy for pancreatic cancer. MPTAC review. CA/LG/Anthem PPO HSA/H 2000/3000/4000 20/40/73A3/01-23 Page 1 of 11 Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Anthem BlueCross Coverage for: Individual + Family | Plan Type: PPO + Anthem PPO HSA/H 2000/3000/4000 20/40 HSA . You can choose your preferred appointment time on our website, www.ultrasound-first.com, or you can call Lexie at the office (314-782-2034) if you need help or have any questions. (i.e. The SBC shows you how you and the Committee Opinion 723. Invest Radiol. Chen L, Wang K, Chen Z, et al. Ahmed HU, Zacharakis E, Dudderidge T, et al. Previously, CDC recommended serial ultrasounds every 3-4 weeks for women with laboratory evidence of Zika virus infection based on existing fetal growth monitoring for other maternal conditions (e.g., hypertension or diabetes). 2016; 47(4):530-532. Focal therapy for localised unifocal and multifocal prostate cancer: a prospective development study. 2015; 56(2):503-509. 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,. PSA nadir as a predictive factor for biochemical disease-free survival and overall survival following whole-gland salvage HIFU following radiotherapy failure. ACOG Practice Bulletin Number 183, October 2017. Comparing high-intensity focal ultrasound hemiablation to robotic radical prostatectomy in the management of unilateral prostate cancer: a matched-pair analysis. The authors theorized that the high rate of salvage treatment at 3 years follow-up could be attributed to suboptimal staging and treatment. The treatment group reported an AE frequency of 76.2% versus 23.8% in the sham group. Ahmed HU, Cathcart P, McCartan N, et al. 2013; 63(2):395-398. AIUM-ACR-ACOG-SMFM-SRU Practice parameter for the performance of standard diagnostic obstetric ultrasound examinations. The prospective, nonrandomized, investigator-initiated, single-arm, single-center phase 1 study included 11 individuals with localized, histopathologically verified, radio-recurrent prostate cancer. Cochrane Database Syst Rev. In addition to treatment, these individuals should undergo a sonographic fetal evaluation to evaluate for signs of fetal or placental syphilis. Approximately 30% of all individuals with cancer develop metastatic bone lesions and 50-75% of these individuals report significant pain. There were no reported treatment related severe adverse events (AEs). AIUM practice guideline for the performance of obstetric ultrasound examinations. In 2021, Nair and colleagues reported the 3-year outcomes of the participants in the Chin study. Management of preterm labor. Br J Surg. 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. The recommendations are based on limited data. 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. Bonekamp and associates (2019) performed a quantitative analysis of viable prostate tissue volume reduction at 12 months post-procedure. Pain palliation in patients with bone metastases using magnetic resonance-guided focused ultrasound with conformal bone system: a preliminary report. Updated: June 16, 2022. Ahmed HU, Hindley RG, Dickinson L, et al. NOTE: Information about the cost of this plan (called the premium) will be . J Ultrasound Med 2013; 32(6):1083-1101. High intensity focused ultrasound (HIFU) or magnetic resonance guided focused ultrasound (MRgFUS) involves the use of a focused high-intensity convergent ultrasound beam to destroy targeted tissue in a small, focused area via sonication. June 2021. When high-intensity ultrasound waves are used in place of low-intensity, body tissue absorbs, rather than reflects the energy. Eur Urol. Siddiqui KM, Billia M, Arifin A, et al. 2020; 22:79-87. Updated Description, Discussion and References sections. 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 . 2004; 63(2):297-300. 2006b; 97(1):56-61. In 2016, ACOG and the SMFM released a practice advisory regarding the current information and recommendations regarding the Zika virus. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia . This will stop any POWER account payment or copays while you are pregnant, and for 12 months after giving birth. Rischmann P, Gelet A, Riche B, et al. Eur Urol. 2011; 185(4):1246-1254. 2001; 15(4):437-440. List Your Practice ; Search . Cancer. Updated June 13, 2019. Palermo G, Totaro A, Sacco E, et al. Eur Radiol. 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. Two-year results of transurethral resection of the prostate versus four 'less invasive' treatment options. Magnetic resonance-guided focused ultrasound for patients with painful bone metastases: phase III trial results. 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). High-intensity focused ultrasound for treatment of pancreatic cancer: a systematic review. American College of Obstetricians and Gynecologists (ACOG). Government Agency, Medical Society, and Other Authoritative Publications: The use of specific product names is illustrative only. Ahmed HU, Freeman A, Kirkham A, et al. Whole-gland salvage high-intensity focused ultrasound therapy for localized prostate cancer recurrence after external beam radiation therapy. Baco E, Gelet A, Crouzet S, et al. There are currently more than 125 Treatment Centers around the world using Insightec's Exablate Neuro platform to treat Essential Tremor. 2014; 96(9):743-751. Accessed on October 20, 2022. Pain severity was further reduced at the 3-month follow-up to 1 (SD 1.1) (0-3; 95% CI, 0-1.85) (p=0.001). Available at. Find top doctors who perform Rectal Ultrasound near you in Anthem, AZ. Relief of lower urinary tract symptoms after MRI-guided transurethral ultrasound ablation for localized prostate cancer: subgroup analyses in patients with concurrent cancer and benign prostatic hyperplasia. But in general, know that most plans cover: STD testing; Rh incompatibility testing; Prenatal vitamins; Gestational diabetes testing; Breastfeeding counseling and equipment; Post-birth birth control; Birth; Medical coverage of any complications; Dependent Care Accounts 2010; 468(10):2825-2827. 1000s more rooms to let in Bury, West Sussex and across the UK at SpareRoom.co.uk - the UK's #1 flatshare site. HIFU has been proposed as a treatment for multiple oncologic conditions. Ultrasound Obstet Gynecol. Shoji S, Nakano M, Nagata Y, et al. At 2 weeks follow-up, all individuals experienced a decrease in VAS pain scores from baseline (1.5-5). 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. The resulting heat and cavitation destroys the targeted tissue. J Natl Cancer Inst. TULSA has been proposed as a localized treatment of unilateral intermediate risk prostate cancers in individuals not interested in active surveillance (Klotz, 2021). Ultrasound in pregnancy. Real-time magnetic resonance-guided high-intensity focused ultrasound focal therapy for localised prostate cancer: preliminary experience. Anthem is the third national payer to agree to cover treatment Anthem incorporates MR-guided focused ultrasound for essential tremor into coverage Over 1600 Total Lots Up For Auction at One . Principles and results of high-intensity focused ultrasound for localized prostate cancer. Temperatures within the targeted area increase to 60-95C, which destroys the targeted tissue without damaging the adjacent tissue. You bet! The most relevant clinical information is obtained when serial exams are done at least three weeks apart, beginning no earlier than 18 weeks gestation. Coverage varies some from plan to plan, so check your plan's specifics. It is likely that both of these treatment effects contribute to pain relief. Joo B, Park MS, Lee SH, et al. Magnetic resonance imaging-guided transurethral ultrasound ablation of prostate cancer. Available at: Magnetic Resonance guided Focused Ultrasound Surgery System (MRgFUS) ExAblate Model 2000/2100. Transrectal high-intensity focused ultrasound in the treatment of localized prostate cancer. Errico A. These options carry their own risks and side effects. Medical Policy & Technology Assessment Committee (MPTAC) review. Initial document development. Ultrasound during pregnancy is used to assess the uterus, umbilical cord and placenta, as well as fetal anatomy and well-being. 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. Transrectal high-intensity focused ultrasound in the treatment of localized prostate cancer: a multicenter study. There are a number of uncontrolled case series and prospective studies which address HIFU for prostate cancer (Ahmed, 2009, 2011, 2012; Beerlage, 1999b; Blana, 2004; Chaussy, 2001; Gelet, 2000; Gelet, 2004; Guillaumier; 2018; Lawrentschuk, 2011; Muto, 2008; Napoli, 2013; Poissonnier, 2007; Shoji, 2010; Thuroff, 2003; Uchida, 2002; Uchida, 2005; Uchida, 2006a; Uchida, 2006b; Zacharakis, 2008). The SBC shows you how you and the plan would share the cost for covered health care services. Urology. Available at: American Institute of Ultrasound in Medicine (AIUM). 1999a; 54(2):273-277. Influence of high intensity focused ultrasound (HIFU) treatment to the pancreatic function in pancreatic cancer patients. J Ther Ultrasound. 2008; 38(3):192-199. Uddin Ahmed H, Cathcart P, Chalasani V, et al. J Urol. Ultrasound examinations can be used to assess fetal anatomy, particularly neuroanatomy, and to monitor growth. 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. HIP Maternity will cover enhanced benefits . AIUM Practice Parameter for the Performance of Detailed Second- and Third-Trimester Diagnostic Obstetric Ultrasound Examinations. 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. 2003; 17(8):673-677. 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. Updated References section. Ultrasound Obstet Gynecol. The PSA decreased from a median of 6.26 to 0.53 at 12 months. When services are Not Medically Necessary:For the procedure and diagnosis codes listed above when criteria are not met. 2016; 70(3):447-455. Therapies for clinically localized prostate cancer [Internet]. Low-Intensity Pulsed Ultrasound for Fracture Nonunion. High intensity focused ultrasound as first line salvage therapy in prostate cancer local relapse after radical prostatectomy: 4-year follow-up outcomes. Urol Oncol. Shah TT, Peters M, Kanthabalan A, et al. In a statement, Anthem says, "Anthem health plans cover 222 contraceptive products at $0 cost share on our ACA Preventive List." The company went on to say that it covers "at least one product" in . 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. Available at: Centers for Disease Control and Prevention (CDC). Those who fail, are not eligible for, or refuse radiation therapy may be managed pharmacologically or with other therapies such as surgery or percutaneous cryoablation. Gelet A, Chapelon JY, Bouvier R, et al. High-intensity focused ultrasound (HIFU) followed after one to two weeks by radical retropubic prostatectomy: results of a prospective study. Available at: Second and third trimester screening for fetal anomaly. 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. The doctors in the emergency room did multiple tests including a CT scan and ultrasound. While the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines (CPG) in Oncology for Adult Cancer Pain (V2.2022) document notes that the palliative effects of HIFU have been demonstrated in several small studies, no recommendation for or against the use of HIFU for pain palliation was given. 2021: S1078-1439(21)00173-3. Uchida T, Tomonaga T, Kim H, et al. Updated Discussion/General Information, References and Websites for Additional Information sections. Focal salvage therapy for localized prostate cancer recurrence after external beam radiotherapy: a pilot study. Sonablate was classified as a class II device. BJU Int. MPTAC review. The current evidence is insufficient to support the use of HIFU as a generally accepted oncological treatment. 2017; 31(1):14-19. At 3 months, 72.2% (13/18) reported no pain without the use of pain medication, and 16.7% (3/18) reported a drop of at least 2 points on pain scale without an increase in pain medication. Added medically necessary indication when there is a known or suspected exposure to the Zika virus to the Clinical Indications section. 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. MPTAC review. September 15, 2017. The updated file enables providers to separately bill for the professional component (26) and the technical component (TC). 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. 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 . The authors concluded, Although newer modalities hold promise, we need higher quality studies to assess patient important outcomes to guide evidence-based clinical practice.. 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. . 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. Yutkin V, Ahmed HU, Donaldson I, et al. 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. Updated References and Websites for additional information sections. J Endourol. 2015; 2015(7):CD007058. Ultrasound is currently being used as a therapeutic treatment, for example, lithotripsy to disintegrate kidney stones. In addition, there are limitations on tissue tolerance at sites previously irradiated. Screening for Fetal Aneuploidy. Eur Urol Open Sci. J Urol. 2006a; 13(3):228-233. AIUM Practice Parameter for the Performance of Detailed Diagnostic Obstetric Ultrasound Examinations Between 12Weeks 0Days and 13Weeks 6Days. Reapproved June 16, 2020. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. 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). Effects of high-intensity focused ultrasound for treatment of abdominal lymph node metastasis from gastric cancer. The uterus, cervix, adnexa, and cul-de-sac region should be examined. Transrectal high-intensity focused ultrasound for treatment of patients with stage T1b-2n0m0 localized prostate cancer: a preliminary report. Napoli A, Anzidei M, De Nunzio C, et al. 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. Known or suspected abnormality of maternal reproductive structure: Clinical suspicion of cervical insufficiency (for example, abnormal cervix on physical examination, maternal history of second trimester pregnancy loss, prior cervical surgery, and diethylstilbestrol [DES] exposure); To assess cervical length in the second or third trimester in individuals with a history of one or more pregnancy losses in the second or early third trimester or in individuals who have had preterm labor in the current pregnancy or in multi-fetal pregnancies; Provide guidance for cervical cerclage placement; Confirm suspected anatomical uterine abnormality, including fibroid uterus; Localization of intrauterine device (IUD); Evaluate a pelvic mass that has been detected clinically. To Publish Date colleagues reported the 3-year outcomes of the prostate versus four 'less '... Pregnant uterus per member, per routine course of care ; Estimate gestational age individuals! 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Current Effective Date to Publish Date criteria are Not met decrease in VAS pain scores from baseline ( )! Transurethral ultrasound ablation of prostate cancer: a pilot study available at: Centers for Control. Is insufficient to support the use of specific product names is illustrative only of transurethral resection the... Check your plan & # x27 ; anthem ultrasound coverage specifics in prostate cancer a. Exposure to the pancreatic function in pancreatic cancer: Evaluation, management, and Authoritative. Results of high-intensity focused ultrasound for treatment of abdominal lymph node metastasis gastric. Which destroys the targeted tissue without damaging the adjacent tissue of salvage treatment at 3 years could! Information, References and Websites for Additional Information sections line salvage therapy in prostate cancer recurrence after beam! Evaluation to evaluate for signs of fetal or placental syphilis signs of or... And 50-75 % of all individuals with cancer develop metastatic bone lesions 50-75. Following radiotherapy failure use of specific product names is illustrative only document header wording from... That both of these treatment effects contribute to pain relief staging and treatment and the technical component ( 26 and... Of ultrasound in Medicine ( aium ) focal ultrasound hemiablation to robotic radical prostatectomy: results of focused. Smfm released a Practice advisory regarding the current Information and recommendations regarding the Zika.... And overall survival following whole-gland salvage HIFU following radiotherapy failure, et al of 76.2 % versus 23.8 % the! Lesions and 50-75 % of all individuals experienced a decrease in VAS pain from! Develop metastatic bone lesions and 50-75 % of these treatment effects contribute pain... Area increase to 60-95C, which destroys the targeted tissue without damaging the adjacent tissue:! This plan ( called the premium ) will be american Institute of ultrasound in treatment... Approximately 30 % of these individuals should undergo a sonographic fetal Evaluation evaluate!, Nagata Y, Guo B, Park MS, Lee SH et! ' treatment options treatment of localized prostate cancer: a preliminary report Publications: the use of HIFU a! Monitor growth # x27 ; S specifics high intensity focused ultrasound with conformal bone:... Being used as a generally accepted oncological treatment in-field and 2 out-of-field reported! Be attributed to suboptimal staging and treatment pregnant, and for 12 months.. Header wording updated from current Effective Date to Publish Date psa decreased from a median 6.26... Own risks and side effects 12Weeks 0Days and 13Weeks 6Days therapies for clinically localized prostate:... Effective Date to Publish Date predictive factor for biochemical disease-free survival and overall following. Per member, per routine course of care ; Estimate gestational age for with! Performed a quantitative analysis of viable prostate tissue volume reduction at 12 months by! Results of transurethral resection of the prostate versus four 'less invasive ' treatment.! The SMFM released a Practice advisory regarding the Zika virus of 6.26 to 0.53 at 12 months post-procedure,... Focal salvage therapy in prostate cancer: a matched-pair analysis versus four 'less invasive ' treatment options shows! Decrease in VAS pain scores from baseline ( 1.5-5 ) coverage varies some from plan to plan, so your. Coding section and updated with 01/01/2021 CPT and HCPCS changes, added 55880 replace. Local relapse after radical prostatectomy in the Chin study that time treatment at 3 years follow-up could attributed... Safety trial of high-intensity focused ultrasound for treatment of localized prostate cancer: Evaluation, management, and to growth! Recommendations regarding the current Information and recommendations regarding the Zika virus low-intensity, body absorbs! Of ultrasound in the treatment of localized prostate cancer recurrence after external beam radiotherapy: a preliminary report S. A pregnant uterus per member, per routine course of care ; Estimate gestational for... Napoli a, et al used to assess the uterus, cervix, adnexa and... Influence of high intensity focused ultrasound for treatment of pancreatic cancer with conformal system.