anthem ultrasound coverage

MedlinePlus. Ganzer R, Robertson CN, Ward JF, et al. Updated Coding section; corrected ICD-10 diagnosis code O41.00X0. 2013; 63(2):395-398. Prostate Cancer. December 2016. The authors reported that salvage TULSA was technically feasible and showed encouraging early results but have not been compared to standard therapy. 2009; 16(1):140-146. The current evidence does not show that clinical outcomes of those undergoing TULSA is similar to those undergoing established alternatives. Crouzet S, Chapelon JY, Rouvire O, et al. Gardner TA, Koch MO. Thuroff S, Chaussy C, Vallancien G, et al. Updated Coding section with 10/01/2016 ICD-10-CM diagnosis code changes. The sound wave echoes are recorded and displayed as a real-time visual image. Updated Coding section with 10/01/2017 ICD-10-CM diagnosis code changes. Chen L, Wang K, Chen Z, et al. 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. Uchida T, Baba S, Irie A, et al. 2011; 185(3):862-868. HIFU has been evaluated as a minimally invasive treatment of whole gland or a focal treatment of prostate cancer, both in the initial treatment of clinically localized prostate cancer and following recurrence. 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. Thuroff S, Chaussy C. High-intensity focused ultrasound: complications and adverse events. There are concerns about inconsistent treatment coverage within renal masses resulting in incomplete ablation. Albisinni S, Aoun F, Bellucci S, et al. The feasibility and safety of high-intensity focused ultrasound as salvage therapy for recurrent prostate cancer following external beam radiotherapy. Clin Orthop Relat Res. 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,. This prospective case series did not compare HIFU long-term survival and morbidity rates with the rates of other standard treatments. Primary pain palliation and local tumor control in bone metastases treated with magnetic resonance-guided focused ultrasound. 2010; 468(10):2825-2827. NCD #220.5. Updated Description, Discussion, References and Websites for Additional Information sections. TULSA has been proposed as a localized treatment of unilateral intermediate risk prostate cancers in individuals not interested in active surveillance (Klotz, 2021). 2019; 29(1):299-308. To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the member's card. Eur Urol. The overall survival (OS) rate was 80%, the progression-free survival (PFS) rate was 94%, and the disease-specific survival rate was 97%. A total of 29 individuals underwent a follow-up biopsy, either at 12 months only, or at 12 and 36 months. In November, the FDA approved the use of Ablatherm (Maple Leaf; Toronto, Canada) to treat prostate cancer in individuals who previously failed radiation therapy. This will stop any POWER account payment or copays while you are pregnant, and for 12 months after giving birth. BJU Int. . 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. 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. Available at: Second and Third Trimester Vaginal Bleeding. 2000; 14(6):519-528. 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.. Researchers used the visual analog pain score (VAS) to measure pain levels. AIUM-ACR-ACOG-SMFM-SRU Practice parameter for the performance of standard diagnostic obstetric ultrasound examinations. Available at: American Cancer Society. Int J Gynaecol Obstet. Pain palliation for localized metastatic bone pain. In 2016, ACOG and the SMFM released a practice advisory regarding the current information and recommendations regarding the Zika virus. 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. MPTAC review. J Urol. Bone metastases are common in breast and prostate cancer (Liberman, 2009). Anttinen and associates (2020) evaluated TULSA use as a partial salvage therapy in individuals with localized, recurrent prostate cancer. Temperatures within the targeted area increase to 60-95C, which destroys the targeted tissue without damaging the adjacent tissue. J Endourol. Addition of cell-free fetal deoxyribonucleic acid (DNA) screening for aneuploidy to Medically Necessary Statement. 2013; 48(6):351-358. The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. HAIFA, Israel - MIAMI, Florida (December 22, 2022) Insightec , a global healthcare company dedicated to using acoustic energy to transform patient care, announced today that Anthem is the third national payor to cover MR-guided Focused Ultrasound for treating medication-refractory Essential Tremor. Updated Discussion, References and Websites for Additional Information sections. 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. J Ther Ultrasound. 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). 2003; 17(8):673-677. Schatzl G, Madersbacher S, Djavan B, et al. 2005; 12(2):2593-2597. Moved content of MED.00119 High Intensity Focused Ultrasound (HIFU) for Oncologic Indications to new clinical utilization management guideline document with the same title. The system protects the urethra and rectum via a water cooling system pumped through the applicator. Lawrentschuk N, Finelli A, Van der Kwast TH, et al. Updated Coding section with 10/01/2020 ICD-10-CM changes; added O99.891; removed Q51.20 deleted 09/30/2020. Due to variances in utilization patterns, each plan may choose whether to adopt a particular Clinical UM Guideline. First analysis of the long-term results with transrectal HIFU in patients with localised prostate cancer. National Coverage Determination: Ultrasound diagnostic procedures. The remaining 11.1% (2/18) reported pain reoccurrence which required pharmacological care. Revised title from High Intensity Focused Ultrasound (HIFU) for Oncologic Indications to Ultrasound Ablation for Oncologic Indications. Uchida T, Tomonaga T, Kim H, et al. Updated Description, Discussion, References and Websites for Additional Information sections. Evaluate for threatened, incomplete, or missed abortion; Non-reassuring fetal heart rate monitoring; Assess amniotic fluid volume in post-term gestation. Updated Coding section with 10/01/2018 ICD-10-CM diagnosis code changes; added Q51.20-Q51.28, Z20.821. 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. Kaur A, Kaur A. Transvaginal ultrasonography in first trimester of pregnancy and its comparison with transabdominal ultrasonography. 2014; 84(5):1157-1162. There were no treatment-related AEs. Systematic review of innovative ablative therapies for the treatment of locally advanced pancreatic cancer. 2014; 114(4):532-540. Li CC, Wang YQ, Li YP, Li XL. Uchida T, Sanghvi NT, Gardner TA, et al. In addition to the active and pending Medical Policies, BCBSIL has included policies which are under development or being revised. However, there are no data specific to congenital Zika virus infection to guide recommendations for timing of serial ultrasounds; ob-gyns and other obstetric providers may consider extending the time interval between ultrasounds in accordance with patient preferences and clinical judgement. This study was a retrospective case series involving 804 subjects who underwent HIFU and were included in an industry-sponsored registry. MPTAC review. Although I've had a particular monthly claim for YEARS, it doesn't always recognize the bill. Napoli A, Anzidei M, Marincola BC, et al. Providers are responsible for billing the appropriate CPT code, modifier, and diagnosis combinations. Ultrasound examinations can be used to assess fetal anatomy, particularly neuroanatomy, and to monitor growth. 2008; 53(6):1194-1201. P110039. 15727 Anthem Pkwy, Suite 600 . 2011; 185(4):1246-1254. Quality of life following high-intensity focused ultrasound for the treatment of localized prostate cancer: a prospective study. The authors concluded, Although newer modalities hold promise, we need higher quality studies to assess patient important outcomes to guide evidence-based clinical practice.. The mean reduction in the NRS score was significant between MRgFUS and placebo (3.6 3.1 versus 0.7 2.4). . Eur Urology. 1000s more rooms to let in Bury, West Sussex and across the UK at SpareRoom.co.uk - the UK's #1 flatshare site. Br J Cancer. 2007; 177(6):2106-2131. Updated Discussion/General Information, Coding and Reference sections. 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 . Participants included those who could not undergo or refused all other available options for pain palliation. Breast MRI costs an average $615 under Medicare . Government Agency, Medical Society, and Other Authoritative Publications: The use of specific product names is illustrative only. This document addresses the use of maternity ultrasound in the outpatient setting. Available at: Dahm P, Brasure M, Ester E, et al. In addition to treatment, these individuals should undergo a sonographic fetal evaluation to evaluate for signs of fetal or placental syphilis. MPTAC review. Eur Urol. 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. 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. Accessed on September 13, 2022. The majority of attributable AEs were grade 1 or 2. 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). Eur Urol. 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 current evidence is insufficient to support the use of HIFU as a generally accepted oncological treatment. 2017; 119(6):896-904. TULSA was developed as an alternative method of prostate tissue ablation. Kenkhuis MJA, Bakker M, Bardi F, ET AL. Update date: March 4, 2022. The value of adding a universal booking scan to an existing protocol of routine mid-gestation ultrasound scan. Contact us today for information about Anthem or for questions regarding Medicaid programs and coverage. By March 2018, Anthem (Blue Cross/Blue Shield) will require that MR and CT scans considered "not medically necessary" be performed at freestanding medical imaging facilities in order to be covered. Ultrasound examinations, particularly if obtained soon after onset of infection, may not identify prenatal features of congenital Zika syndrome and structural manifestations can be identified at later points in pregnancy. Urology. . Centers for Disease Control and Prevention (CDC). PLoS One. 2017; 120(2):246-256. Urology. The authors reported technically precise results and showed that the treatment can be targeted within a narrow range. Rombouts SJ, Vogel JA, van Santvoort HC, et al. Prostate Cancer Prostatic Dis. 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. The resulting heat and cavitation destroys the targeted tissue. 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 . The document header wording updated from Current Effective Date to Publish Date. Updated Discussion/General Information, References and Websites for Additional Information sections. Added Websites for Additional Information section. Participants were followed for up to 5 years post-procedure. Available at: Limited obstetrical ultrasound examination. Alldred SK, Takwoingi Y, Guo B, et al. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Insurance coverage for whole-breast ultrasound is evolving. 2021; 127(5):544-552. CPT codes Dx codes 76801 76802 D25, D25.0, D25.1, D25.2, D25.9, O0900, O0901, O0902, O0903, O09511, O09512, The new Multiple Delivery policy has the same . Magnetic resonance imaging-guided transurethral ultrasound ablation in patients with localised prostate cancer: 3-year outcomes of a prospective Phase I study. 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). Prudent use and safety diagnostic ultrasound in pregnancy. Summary of coverage and benefits PDF Service coverage and costs All employee health insurance plans provide one annual preventive care visit with your primary care provider at $0 co-pay within specified networks. There was 1 in-field and 2 out-of-field recurrences reported at that time. No. Prostate Cancer (V1.2023). Grade 3 (n=1) and grade 2 (n=3) AEs related to urinary retention and urinary tract infection were reported. J Endourol. close combat footage enemy visible bungee fitness dickson tn Tue, Oct 18 2022 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. In October 2017, ACOG and SMFM released an updated version of the practice advisory based upon updated Centers for Disease Control and Prevention (CDC) recommendations and recently published guidance. Birth Defects Homepage: Diagnosis. 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. Focal therapies are proposed as less invasive treatment options when compared to radical prostatectomy or radiation therapy. Magnetic resonance imaging-guided transurethral ultrasound ablation of prostate cancer. Available at: AUA / American Society for Radiation Oncology (ASTRO) / Society of Urologic Oncology (SUO). Updated Coding section to add ICD-10-CM diagnosis codes O09.00-O09.03, O09.811-O09.829. 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. American College of Obstetricians and Gynecologists (ACOG). 2015; 193(1):103-110. The majority of events were minor and reversible. There were 12 grade 3 adverse events (AEs) attributable to the TULSA-PRO, all of which were resolved by 12 months. 2018; 51(4):463-469. 510K Premarket notification. This document addresses ultrasound ablative therapy for the treatment of oncologic conditions. Peek MC, Ahmed M, Napoli A, et al. Rischmann P, Gelet A, Riche B, et al. J Endourol. Ultrasound Obstet Gynecol. Hoosier Healthwise. 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. 2015 Mar;34(3):435-440. 2005; 4(3):187-192. Cochrane Database Syst Rev. Control of prostate cancer by transrectal HIFU in 227 patients. 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. 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. PSA nadir as a predictive factor for biochemical disease-free survival and overall survival following whole-gland salvage HIFU following radiotherapy failure. The SBC shows you how you and the plan would share the cost for covered health care services. AIUM practice guideline for the performance of obstetric ultrasound examinations. Ultrasound Obstet Gynecol. 2015; 10(2):e0118212. Ultrasound is currently being used as a therapeutic treatment, for example, lithotripsy to disintegrate kidney stones. Transrectal high-intensity focused ultrasound in the treatment of localized prostate cancer. Ann Surg Oncol. American College of Obstetricians and Gynecologists (ACOG). Beerlage HP, Thuroff S, Debruyne FM, et al. CA/SG/Anthem Platinum PPO 15/250/10%/6BPB/01-22 Page 1 of 13 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: PPO Anthem Platinum PPO 15/250/10% The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. U.S. Food and Drug Administration (FDA). Cochrane Database Syst Rev. Bonekamp D, Wolf MB, Roethke MC, et al. Peek and associates (2015) conducted a systematic review of the use of HIFU in breast cancer. October 2016. Anthem - Blue Cross Blue Shield Long awaited and much anticipated? Napoli A, Anzidei M, De Nunzio C, et al. Magnetic resonance imaging-guided transurethral ultrasound ablation of prostate tissue in patients with localized prostate cancer: a prospective Phase 1 clinical trial. Hurwitz MD, Ghanouni P, Kanaev SV, et al. Ultrasound imaging can be used after delivery to evaluate abnormalities of the reproductive and adjacent structures. 2016; 47(4):530-532. Replaced term women with individual within clinical indications. 2006a; 13(3):228-233. Step 1: Report your pregnancy to your health plan. Eur Urol. Comprehensive medical coverage that covers many common services at no cost or for a low copay. Practice Advisory Interim Guidance for Care of Obstetric Patients During a Zika Virus Outbreak. J Natl Cancer Inst. In 2013, Napoli and colleagues treated 18 individuals with painful bone metastases with MRgFUS. Available at: American Institute of Ultrasound in Medicine (AIUM). Chaussy C, Thuroff S, Rebillard X, Gelet A. -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. MPTAC review. 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. Sofuni A, Moriyasu F, Sano T, et al. Free healthcare job search site: Ultrasound Tech/Sonographer Sonography/Sono job in Tuba City Arizona, USA. 2011; 3(3):329-338. Ahhhhh! Unlisted procedure, breast [when specified as destruction of breast tissue by high intensity focused ultrasound], Unlisted procedure, urinary system [when specified as transurethral MRI directional ultrasound ablation of prostate tissue (TULSA)], Ablation of malignant prostate tissue, transrectal, with high intensity-focused ultrasound (HIFU), including ultrasound guidance. Int J Clin Pract. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. Obstetric Care Consensus. Cancer. One of the largest of these studies was conducted by Ganzer and colleagues (2011). Br J Surg. 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. June 2021. BJU Int. 2004; 58(4):382-390. This document does not address nuchal translucency. Results indicated that median survival in RFA, IRE and SBRT was more favorable compared to HIFU. . Shah TT, Peters M, Kanthabalan A, et al. J Endourol. 2010; 17(8):715-719. Anthem Blue Cross and Blue Shield - BlueAdvantage POS Colorado Higher Education Insurance Benefits Alliance Trust Coverage for: Individual + Family | Plan Type: HMO . Int J Urol. Postpartum hemorrhage. 2014; 11(6):303. 2012; 116(3):201-205. The doctors in the emergency room did multiple tests including a CT scan and ultrasound. HIFU was comparable to the median survival in standard chemotherapy. ; AUA Prostate Cancer Clinical Guideline Update Panel. Focal salvage therapy for localized prostate cancer recurrence after external beam radiotherapy: a pilot study. Effects of high-intensity focused ultrasound for treatment of abdominal lymph node metastasis from gastric cancer. 2021; 205(3):769-779. Focal therapy for localized prostate cancer: a phase I/II trial. MPTAC review. CA/IND/Anthem Silver 94 HMO/657X/01-22 Page 1 of 11 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 94 HMO The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Bone pain is a common complaint for individuals with metastatic cancer to the bone. Whole-gland ablation of localized prostate cancer with high-intensity focused ultrasound: oncologic outcomes and morbidity in 1002 patients. High Intensity Ultrasound System For Prostate Tissue Ablation (Ablatherm). 1999b; 39(1):41-46. Jpn J Clin Oncol. Updated Coding section with additional diagnosis codes D25.0-D25.9, O26.872-O26.879, O99.210-O99.213, O99.810. Comparing high-intensity focal ultrasound hemiablation to robotic radical prostatectomy in the management of unilateral prostate cancer: a matched-pair analysis. 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.

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