2021. Magnetic resonance imaging-guided transurethral ultrasound ablation of prostate cancer. 2011; 185(4):1246-1254. Management of prostate-specific antigen relapse in prostate cancer: a European Consensus. One of the largest of these studies was conducted by Ganzer and colleagues (2011). This study was defined by the regulatory agency to evaluate the effectiveness of the device to ablate prostate tissue. Updated Coding section with additional diagnosis codes D25.0-D25.9, O26.872-O26.879, O99.210-O99.213, O99.810. MPTAC review. There are currently two ultrasound ablative techniques. World J Gastroenterol. Bone pain is a common complaint for individuals with metastatic cancer to the bone. BJU Int. . 2016; 70(3):447-455. At 12 months, the majority of participants (10/11) were cancer free in the ablated area and maintained a low stable PSA. 2018; 51(4):463-469. Available at: U.S. National Library of Medicine. Updated References. 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,. Uchida T, Tomonaga T, Kim H, et al. J Urol. Transurethral ultrasound ablation (TULSA), which delivers directional thermal ultrasound via a catheter inserted into the urethra, is specific to prostate cancer. Updated: June 16, 2022. Thuroff S, Chaussy C, Vallancien G, et al. Liberman B, Gianfelice D, Inbar Y, et al. There was 1 in-field and 2 out-of-field recurrences reported at that time. The benefits and limitations of ultrasonography should be discussed with all patients. J Endourol. Day 1 health insurance coverage and comprehensive benefits options 401(k) matching program Eur Urol. Pain palliation in patients with bone metastases using MR-guided focused ultrasound surgery: a multicenter study. Beerlage HP, van Leenders GJ, Oosterhof GO, et al. Anttinen M, Mkel P, Viitala A, et al. Available at: Centers for Disease Control and Prevention (CDC). The SBC shows you how you and the 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). This document addresses the use of maternity ultrasound in the outpatient setting. Revised September 16, 2022. Salvage high-intensity focused ultrasound (HIFU) for locally recurrent prostate cancer after failed radiation therapy: Multi-institutional analysis of 418 patients. 2005; 51(10):651-658. Bertrand AS, Iannessi A, Natale R, et al. Effectiveness of 12-13-week scan for early diagnosis of fetal congenital anomalies in the cell-free DNA era. The prospective, nonrandomized, investigator-initiated, single-arm, single-center phase 1 study included 11 individuals with localized, histopathologically verified, radio-recurrent prostate cancer. Updated Coding section with 10/01/2022 ICD-10-CM changes; added O35.00X0-O35.9XX9 replacing O35.0XX0-O35.9XX9. Due to variances in utilization patterns, each plan may choose whether to adopt a particular Clinical UM Guideline. J Ther Ultrasound. The baseline median PSA of 7.6 ng/ml decreased to 0.23 ng/ml at 12 months follow-up. Medical Policy & Technology Assessment Committee (MPTAC) review. NCD #220.5. 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. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise, without permission from the health plan. Sonablate was classified as a class II device. Required ultrasound or colonoscopy for select adult patients based on clinical scenario; Ultrasound-first approach for pediatric abdominal and pelvic pain . Prostate cancer is the second leading cause of death with approximately 39,430 deaths in 2018 (Bekelman, 2018). ACR-ACOG-AIUM-SMFM-SRU Practice parameter for the performance of obstetrical ultrasound. Control of prostate cancer by transrectal HIFU in 227 patients. 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. The 2018 American Urological Association/American Society for Radiation Oncology/Society of Urologic Oncology (AUA/ASCO/SUO) notes that high intensity focused ultrasound treatment is not a standard care option for low, intermediate or high risk or localized prostate cancer. Thompson I, Thrasher JB, Aus G, et al. 2011; 3(3):329-338. Find top doctors who perform Rectal Ultrasound near you in Anthem, AZ. 2013; 48(6):351-358. In Ohio: Community Insurance Company. Pain palliation for localized metastatic bone pain. Available at: ACOG. 2004; 58(4):382-390. * From Jawad MU, Scully SP. Zip Code or City, State . Pregnant Women. Added medically necessary indication when there is a known or suspected exposure to the Zika virus to the Clinical Indications section. 2014; 20(28):9570-9577. Routine Tests During Pregnancy. Clin Oncol (R Coll Radiol). 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. The authors noted that incomplete tumor ablation could be related to poor accuracy in determining the target area or movement during the procedure. Ahmed HU, Hindley RG, Dickinson L, et al. Federal and State law, as well as contract language, and Medical Policy take precedence over Clinical UM Guidelines. However, comparisons involving HIFU were limited to radical prostatectomy because of a lack of studies comparing HIFU to other therapies. Although the exact mechanism of analgesic action of MRgFUS in pain palliation is unknown, studies have pointed to a few explanations. . 510K Premarket notification. The location you tried did not return a result. J Endourol. June 7, 2018. A complete resolution of pain at 1 year follow-up was shown in 2 participants (Joo, 2015). 2016; 19(3):311-316. J Endourol. AIUM practice guideline for the performance of obstetric ultrasound examinations. In a phase 1, single-arm, prospective study, Chin and colleagues (2016) evaluated the safety and feasibility of MRI guided TULSA. J Urol. American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal Fetal Medicine (SMFM). MPTAC review. Temperatures within the targeted area increase to 60-95C, which destroys the targeted tissue without damaging the adjacent tissue. Sexually Transmitted Infections Treatment Guidelines, 2021. The current evidence does not show that clinical outcomes of those undergoing TULSA is similar to those undergoing established alternatives. Therapies for clinically localized prostate cancer [Internet]. Int J Gynaecol Obstet. 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. . Kaur A, Kaur A. Transvaginal ultrasonography in first trimester of pregnancy and its comparison with transabdominal ultrasonography. Magnetic resonance imaging-guided transurethral ultrasound ablation of prostate tissue in patients with localized prostate cancer: a prospective Phase 1 clinical trial. The TULSA-PRO (Profound Medical Corp., Fort Myers, FL) received 510(k) clearance by the FDA in 2019. For appeals related to well-being incentive credits, 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. HIP Maternity will cover enhanced benefits . Prostate cancer is the most commonly diagnosed cancer in men, accounting for 19% of all new cancer cases. Chin JL, Billia M, Relle J, et al. 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). 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. Uchida T, Sanghvi NT, Gardner TA, et al. The majority of attributable AEs were grade 1 or 2. The remaining 11.1% (2/18) reported pain reoccurrence which required pharmacological care. FAQ 133, July 2021. Ahmed HU, Cathcart P, McCartan N, et al. Effects of high-intensity focused ultrasound for treatment of abdominal lymph node metastasis from gastric cancer. Anthem isn't the only insurer trying to find a way around hospitals' steeper costs for outpatient imaging, says Lea Halim, a senior consultant at the Advisory Board, a health care research and. In the obese patient, expectations regarding visualization of fetal anatomy should be tempered. Updated References and Websites for additional information sections. In addition to the active and pending Medical Policies, BCBSIL has included policies which are under development or being revised. Added Websites for Additional Information section. Available at. Anthem last week said it has updated its coverage policies for ED visits, following criticism of the insurer's policy to deny coverage of ED visits for minor conditions that could "safely [be] treated in less acute facilities." Learn more: Get the primers for reducing avoidable ED utilization Background Bone metastases are common in breast and prostate cancer (Liberman, 2009). While there is no reliable evidence to support ultrasounds performed during pregnancy will harm a fetus, there is general agreement that the casual use of ultrasonography during pregnancy should be avoided (ACOG, 2018). These resources can help members understand their maternity benefits. The wait is over. CPT Only - American Medical Association, RAD.00038 Use of 3-D, 4-D or 5-D Ultrasound in Maternity Care, https://www.acog.org/-/media/project/acog/acogorg/clinical/files/committee-opinion/articles/2017/10/guidelines-for-diagnostic-imaging-during-pregnancy-and-lactation.pdf, https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2018/12/placenta-accreta-spectrum, https://www.acog.org/clinical/clinical-guidance/practice-bulletin, https://www.smfm.org/publications/220-acog-smfm-joint-practice-advisory-interim-guidance-for-care-of-obstetric-patients-during-a-zika-virus-outbreak, https://www.acr.org/-/media/ACR/Files/Practice-Parameters/US-OB.pdf, https://acsearch.acr.org/docs/69465/Narrative/?_ga=2.211725906.656052169.1601908671-191399006.1564351312, https://acsearch.acr.org/docs/3102400/Narrative/, https://www.aium.org/resources/guidelines/obstetric.pdf, https://www.aium.org/resources/statements.aspx, https://www.aium.org/resources/guidelines.aspx, https://www.cdc.gov/std/treatment-guidelines/STI-Guidelines-2021.pdf, https://www.cdc.gov/zika/hc-providers/types-of-tests.html, https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/ncd103c1_part4.pdf, https://www.acog.org/Patients/FAQs/Routine-Tests-During-Pregnancy, https://www.cdc.gov/ncbddd/birthdefects/diagnosis.html, https://www.cdc.gov/zika/prevention/index.html, https://medlineplus.gov/ency/presentations/100197_1.htm. Available at: American Institute of Ultrasound in Medicine (AIUM). Reformatted Coding section. The document header wording updated from Current Effective Date to Publish Date. Updated Discussion/General Information, References and Websites for Additional Information sections. Li CC, Wang YQ, Li YP, Li XL. An mpMRI, a transrectal ultrasound guided biopsy and a cystoscopy were performed at 12 months post-procedure. Ultrasound is currently being used as a therapeutic treatment, for example, lithotripsy to disintegrate kidney stones. 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 . 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. Klotz L, Pavlovich CP, Chin J, et al. The treatment group reported an AE frequency of 76.2% versus 23.8% in the sham group. The majority of events were minor and reversible. . 2006a; 13(3):228-233. Bonekamp and associates (2019) performed a quantitative analysis of viable prostate tissue volume reduction at 12 months post-procedure. July 25, 2018. NOTE: Information about the cost of this plan (called the premium) will be . Br J Cancer. This early study focused on safety and technical feasibility rather than clinical outcomes. Adverse events included grade 1 or 2 hematuria, urinary tract infections or acute urinary retention, and grade 3 epididymitis. Number 7. Contact us today for information about Anthem or for questions regarding Medicaid programs and coverage. In 2016, ACOG and the SMFM released a practice advisory regarding the current information and recommendations regarding the Zika virus. Schatzl G, Madersbacher S, Djavan B, et al. Real-time magnetic resonance-guided high-intensity focused ultrasound focal therapy for localised prostate cancer: preliminary experience. Rejection notice to me (if I'm lucky) and I start over. Kenkhuis MJA, Bakker M, Bardi F, ET AL. Prostate cancer therapy with high-intensity focused ultrasound. November 6, 2015. AIUM Practice Parameter for the Performance of Detailed Diagnostic Obstetric Ultrasound Examinations Between 12Weeks 0Days and 13Weeks 6Days. Assess significant discrepancy between uterine size and dates; Follow-up for observation of identified fetal or cord anomaly; Evaluate suspected fetal growth abnormality (either growth restriction or macrosomia), and to follow proven or suspected intrauterine growth restriction; Confirm suspected or follow confirmed diagnosis of polyhydramnios or oligohydramnios; Estimate fetal weight or presentation in premature rupture of membranes or preterm labor; Serial evaluation of fetal growth in multi-fetal pregnancy. 2004; 63(2):297-300. A complete retroperitoneal US study visualizes all the structures or organs within the anatomic description of that study. Clin Genitourin Cancer. Eur Urol. 2000; 14(6):519-528. Whitworth M, Bricker L, Mullan C. Ultrasound for fetal assessment in early pregnancy. List Your Practice ; Search . The mean reduction in the NRS score was significant between MRgFUS and placebo (3.6 3.1 versus 0.7 2.4). 2017; 71(2):267-273. 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.. Cochrane Database Syst Rev. Focal therapy for localised unifocal and multifocal prostate cancer: a prospective development study. Participants included those who could not undergo or refused all other available options for pain palliation. Palermo G, Totaro A, Sacco E, et al. grievance or appeal. $0 plans in select areas. Shi Y, Ying X, Hu X, et al. 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). Principles and results of high-intensity focused ultrasound for localized prostate cancer. While the analysis showed superior survival rates at 6 and 12 months in the groups which included HIFU in combination therapy, the authors noted that the overall quality of the studies was poor. Pak J Pharm Sci. Reviewed and validity confirmed 2011. It is likely that both of these treatment effects contribute to pain relief. 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. In some states, insurance must cover . The difference in response rates between MRgFUS and placebo at 3 months was significant (64.3% versus 20.0%).
anthem ultrasound coverage
2021. Magnetic resonance imaging-guided transurethral ultrasound ablation of prostate cancer. 2011; 185(4):1246-1254. Management of prostate-specific antigen relapse in prostate cancer: a European Consensus. One of the largest of these studies was conducted by Ganzer and colleagues (2011). This study was defined by the regulatory agency to evaluate the effectiveness of the device to ablate prostate tissue. Updated Coding section with additional diagnosis codes D25.0-D25.9, O26.872-O26.879, O99.210-O99.213, O99.810. MPTAC review. There are currently two ultrasound ablative techniques. World J Gastroenterol. Bone pain is a common complaint for individuals with metastatic cancer to the bone. BJU Int. . 2016; 70(3):447-455. At 12 months, the majority of participants (10/11) were cancer free in the ablated area and maintained a low stable PSA. 2018; 51(4):463-469. Available at: U.S. National Library of Medicine. Updated References. 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,. Uchida T, Tomonaga T, Kim H, et al. J Urol. Transurethral ultrasound ablation (TULSA), which delivers directional thermal ultrasound via a catheter inserted into the urethra, is specific to prostate cancer. Updated: June 16, 2022. Thuroff S, Chaussy C, Vallancien G, et al. Liberman B, Gianfelice D, Inbar Y, et al. There was 1 in-field and 2 out-of-field recurrences reported at that time. The benefits and limitations of ultrasonography should be discussed with all patients. J Endourol. Day 1 health insurance coverage and comprehensive benefits options 401(k) matching program Eur Urol. Pain palliation in patients with bone metastases using MR-guided focused ultrasound surgery: a multicenter study. Beerlage HP, van Leenders GJ, Oosterhof GO, et al. Anttinen M, Mkel P, Viitala A, et al. Available at: Centers for Disease Control and Prevention (CDC). The SBC shows you how you and the 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). This document addresses the use of maternity ultrasound in the outpatient setting. Revised September 16, 2022. Salvage high-intensity focused ultrasound (HIFU) for locally recurrent prostate cancer after failed radiation therapy: Multi-institutional analysis of 418 patients. 2005; 51(10):651-658. Bertrand AS, Iannessi A, Natale R, et al. Effectiveness of 12-13-week scan for early diagnosis of fetal congenital anomalies in the cell-free DNA era. The prospective, nonrandomized, investigator-initiated, single-arm, single-center phase 1 study included 11 individuals with localized, histopathologically verified, radio-recurrent prostate cancer. Updated Coding section with 10/01/2022 ICD-10-CM changes; added O35.00X0-O35.9XX9 replacing O35.0XX0-O35.9XX9. Due to variances in utilization patterns, each plan may choose whether to adopt a particular Clinical UM Guideline. J Ther Ultrasound. The baseline median PSA of 7.6 ng/ml decreased to 0.23 ng/ml at 12 months follow-up. Medical Policy & Technology Assessment Committee (MPTAC) review. NCD #220.5. 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. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise, without permission from the health plan. Sonablate was classified as a class II device. Required ultrasound or colonoscopy for select adult patients based on clinical scenario; Ultrasound-first approach for pediatric abdominal and pelvic pain . Prostate cancer is the second leading cause of death with approximately 39,430 deaths in 2018 (Bekelman, 2018). ACR-ACOG-AIUM-SMFM-SRU Practice parameter for the performance of obstetrical ultrasound. Control of prostate cancer by transrectal HIFU in 227 patients. 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. The 2018 American Urological Association/American Society for Radiation Oncology/Society of Urologic Oncology (AUA/ASCO/SUO) notes that high intensity focused ultrasound treatment is not a standard care option for low, intermediate or high risk or localized prostate cancer. Thompson I, Thrasher JB, Aus G, et al. 2011; 3(3):329-338. Find top doctors who perform Rectal Ultrasound near you in Anthem, AZ. 2013; 48(6):351-358. In Ohio: Community Insurance Company. Pain palliation for localized metastatic bone pain. Available at: ACOG. 2004; 58(4):382-390. * From Jawad MU, Scully SP. Zip Code or City, State . Pregnant Women. Added medically necessary indication when there is a known or suspected exposure to the Zika virus to the Clinical Indications section. 2014; 20(28):9570-9577. Routine Tests During Pregnancy. Clin Oncol (R Coll Radiol). 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. The authors noted that incomplete tumor ablation could be related to poor accuracy in determining the target area or movement during the procedure. Ahmed HU, Hindley RG, Dickinson L, et al. Federal and State law, as well as contract language, and Medical Policy take precedence over Clinical UM Guidelines. However, comparisons involving HIFU were limited to radical prostatectomy because of a lack of studies comparing HIFU to other therapies. Although the exact mechanism of analgesic action of MRgFUS in pain palliation is unknown, studies have pointed to a few explanations. . 510K Premarket notification. The location you tried did not return a result. J Endourol. June 7, 2018. A complete resolution of pain at 1 year follow-up was shown in 2 participants (Joo, 2015). 2016; 19(3):311-316. J Endourol. AIUM practice guideline for the performance of obstetric ultrasound examinations. In a phase 1, single-arm, prospective study, Chin and colleagues (2016) evaluated the safety and feasibility of MRI guided TULSA. J Urol. American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal Fetal Medicine (SMFM). MPTAC review. Temperatures within the targeted area increase to 60-95C, which destroys the targeted tissue without damaging the adjacent tissue. Sexually Transmitted Infections Treatment Guidelines, 2021. The current evidence does not show that clinical outcomes of those undergoing TULSA is similar to those undergoing established alternatives. Therapies for clinically localized prostate cancer [Internet]. Int J Gynaecol Obstet. 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. . Kaur A, Kaur A. Transvaginal ultrasonography in first trimester of pregnancy and its comparison with transabdominal ultrasonography. Magnetic resonance imaging-guided transurethral ultrasound ablation of prostate tissue in patients with localized prostate cancer: a prospective Phase 1 clinical trial. The TULSA-PRO (Profound Medical Corp., Fort Myers, FL) received 510(k) clearance by the FDA in 2019. For appeals related to well-being incentive credits, 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. HIP Maternity will cover enhanced benefits . Prostate cancer is the most commonly diagnosed cancer in men, accounting for 19% of all new cancer cases. Chin JL, Billia M, Relle J, et al. 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). 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. Uchida T, Sanghvi NT, Gardner TA, et al. The majority of attributable AEs were grade 1 or 2. The remaining 11.1% (2/18) reported pain reoccurrence which required pharmacological care. FAQ 133, July 2021. Ahmed HU, Cathcart P, McCartan N, et al. Effects of high-intensity focused ultrasound for treatment of abdominal lymph node metastasis from gastric cancer. Anthem isn't the only insurer trying to find a way around hospitals' steeper costs for outpatient imaging, says Lea Halim, a senior consultant at the Advisory Board, a health care research and. In the obese patient, expectations regarding visualization of fetal anatomy should be tempered. Updated References and Websites for additional information sections. In addition to the active and pending Medical Policies, BCBSIL has included policies which are under development or being revised. Added Websites for Additional Information section. Available at. Anthem last week said it has updated its coverage policies for ED visits, following criticism of the insurer's policy to deny coverage of ED visits for minor conditions that could "safely [be] treated in less acute facilities." Learn more: Get the primers for reducing avoidable ED utilization Background Bone metastases are common in breast and prostate cancer (Liberman, 2009). While there is no reliable evidence to support ultrasounds performed during pregnancy will harm a fetus, there is general agreement that the casual use of ultrasonography during pregnancy should be avoided (ACOG, 2018). These resources can help members understand their maternity benefits. The wait is over. CPT Only - American Medical Association, RAD.00038 Use of 3-D, 4-D or 5-D Ultrasound in Maternity Care, https://www.acog.org/-/media/project/acog/acogorg/clinical/files/committee-opinion/articles/2017/10/guidelines-for-diagnostic-imaging-during-pregnancy-and-lactation.pdf, https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2018/12/placenta-accreta-spectrum, https://www.acog.org/clinical/clinical-guidance/practice-bulletin, https://www.smfm.org/publications/220-acog-smfm-joint-practice-advisory-interim-guidance-for-care-of-obstetric-patients-during-a-zika-virus-outbreak, https://www.acr.org/-/media/ACR/Files/Practice-Parameters/US-OB.pdf, https://acsearch.acr.org/docs/69465/Narrative/?_ga=2.211725906.656052169.1601908671-191399006.1564351312, https://acsearch.acr.org/docs/3102400/Narrative/, https://www.aium.org/resources/guidelines/obstetric.pdf, https://www.aium.org/resources/statements.aspx, https://www.aium.org/resources/guidelines.aspx, https://www.cdc.gov/std/treatment-guidelines/STI-Guidelines-2021.pdf, https://www.cdc.gov/zika/hc-providers/types-of-tests.html, https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/ncd103c1_part4.pdf, https://www.acog.org/Patients/FAQs/Routine-Tests-During-Pregnancy, https://www.cdc.gov/ncbddd/birthdefects/diagnosis.html, https://www.cdc.gov/zika/prevention/index.html, https://medlineplus.gov/ency/presentations/100197_1.htm. Available at: American Institute of Ultrasound in Medicine (AIUM). Reformatted Coding section. The document header wording updated from Current Effective Date to Publish Date. Updated Discussion/General Information, References and Websites for Additional Information sections. Li CC, Wang YQ, Li YP, Li XL. An mpMRI, a transrectal ultrasound guided biopsy and a cystoscopy were performed at 12 months post-procedure. Ultrasound is currently being used as a therapeutic treatment, for example, lithotripsy to disintegrate kidney stones. 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 . 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. Klotz L, Pavlovich CP, Chin J, et al. The treatment group reported an AE frequency of 76.2% versus 23.8% in the sham group. The majority of events were minor and reversible. . 2006a; 13(3):228-233. Bonekamp and associates (2019) performed a quantitative analysis of viable prostate tissue volume reduction at 12 months post-procedure. July 25, 2018. NOTE: Information about the cost of this plan (called the premium) will be . Br J Cancer. This early study focused on safety and technical feasibility rather than clinical outcomes. Adverse events included grade 1 or 2 hematuria, urinary tract infections or acute urinary retention, and grade 3 epididymitis. Number 7. Contact us today for information about Anthem or for questions regarding Medicaid programs and coverage. In 2016, ACOG and the SMFM released a practice advisory regarding the current information and recommendations regarding the Zika virus. Schatzl G, Madersbacher S, Djavan B, et al. Real-time magnetic resonance-guided high-intensity focused ultrasound focal therapy for localised prostate cancer: preliminary experience. Rejection notice to me (if I'm lucky) and I start over. Kenkhuis MJA, Bakker M, Bardi F, ET AL. Prostate cancer therapy with high-intensity focused ultrasound. November 6, 2015. AIUM Practice Parameter for the Performance of Detailed Diagnostic Obstetric Ultrasound Examinations Between 12Weeks 0Days and 13Weeks 6Days. Assess significant discrepancy between uterine size and dates; Follow-up for observation of identified fetal or cord anomaly; Evaluate suspected fetal growth abnormality (either growth restriction or macrosomia), and to follow proven or suspected intrauterine growth restriction; Confirm suspected or follow confirmed diagnosis of polyhydramnios or oligohydramnios; Estimate fetal weight or presentation in premature rupture of membranes or preterm labor; Serial evaluation of fetal growth in multi-fetal pregnancy. 2004; 63(2):297-300. A complete retroperitoneal US study visualizes all the structures or organs within the anatomic description of that study. Clin Genitourin Cancer. Eur Urol. 2000; 14(6):519-528. Whitworth M, Bricker L, Mullan C. Ultrasound for fetal assessment in early pregnancy. List Your Practice ; Search . The mean reduction in the NRS score was significant between MRgFUS and placebo (3.6 3.1 versus 0.7 2.4). 2017; 71(2):267-273. 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.. Cochrane Database Syst Rev. Focal therapy for localised unifocal and multifocal prostate cancer: a prospective development study. Participants included those who could not undergo or refused all other available options for pain palliation. Palermo G, Totaro A, Sacco E, et al. grievance or appeal. $0 plans in select areas. Shi Y, Ying X, Hu X, et al. 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). Principles and results of high-intensity focused ultrasound for localized prostate cancer. While the analysis showed superior survival rates at 6 and 12 months in the groups which included HIFU in combination therapy, the authors noted that the overall quality of the studies was poor. Pak J Pharm Sci. Reviewed and validity confirmed 2011. It is likely that both of these treatment effects contribute to pain relief. 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. In some states, insurance must cover . The difference in response rates between MRgFUS and placebo at 3 months was significant (64.3% versus 20.0%).
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