Salvage high-intensity focused ultrasound (HIFU) for locally recurrent prostate cancer after failed radiation therapy: Multi-institutional analysis of 418 patients. However, the change from baseline in MEDD intake was not statistically significant, although the authors noted a trend towards a statistically significant change. That coverage comes at a cost, however; specifically, Plan F is the most expensive of all the MedSup policies on the market today. Low-Intensity Pulsed Ultrasound for Fracture Nonunion. Addition of cell-free fetal deoxyribonucleic acid (DNA) screening for aneuploidy to Medically Necessary Statement. Ultrasound abnormalities have been detected in the fetus from 2 to 29 weeks after symptom onset, and therefore, insufficient data are available to define the optimal timing between exposure and initial sonographic screening. The clearance was based upon the Ablatherm device as the predicate device. . Ultrasound examinations can be used to assess fetal anatomy, particularly neuroanatomy, and to monitor growth. The limited examination of small biopsies as well as the lack of a reliable means of assessing some prognostic factors, such as potential lymphovascular invasion, may not provide adequate information for the determination of adjuvant systemic therapies. MPTAC review. Ann Surg Oncol. Focal therapy for localized prostate cancer: a phase I/II trial. J Bone Joint Surg Am. The feasibility and safety of high-intensity focused ultrasound as salvage therapy for recurrent prostate cancer following external beam radiotherapy. 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 . The sound wave echoes are recorded and displayed as a real-time visual image. 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 . The document header wording updated from Current Effective Date to Publish Date. Updated Discussion/General Information, References and Websites for Additional Information sections. Available at: Second and third trimester screening for fetal anomaly. 2015; 2015(6):CD001451. 510K Premarket notification. Gardner TA, Koch MO. Peek and associates (2015) conducted a systematic review of the use of HIFU in breast cancer. Updated Coding section with 10/01/2022 ICD-10-CM changes; added O35.00X0-O35.9XX9 replacing O35.0XX0-O35.9XX9. The current evidence does not show that clinical outcomes of those undergoing TULSA is similar to those undergoing established alternatives. 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. $0 plans in select areas. 15727 Anthem Pkwy, Suite 600 . 2015 Mar;34(3):435-440. J Endourol. Medical Encyclopedia. TULSA has been proposed as a localized treatment of unilateral intermediate risk prostate cancers in individuals not interested in active surveillance (Klotz, 2021). Pain palliation for localized metastatic bone pain. 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. Ahhhhh! A total of 23 studies comprised of 1157 individuals were included. The overall survival (OS) rate was 80%, the progression-free survival (PFS) rate was 94%, and the disease-specific survival rate was 97%. * Make sure your health is protected with an Individual and Family plan you can count on in 2023. Zacharakis E, Ahmed HU, Ishaq A, et al. This guideline was reviewed and validated in 2011. Jpn J Clin Oncol. 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). Added medically necessary indication when there is a known or suspected exposure to the Zika virus to the Clinical Indications section. Bertrand AS, Iannessi A, Natale R, et al. Government Agency, Medical Society, and Other Authoritative Publications: The use of specific product names is illustrative only. Evaluate for threatened, incomplete, or missed abortion; Non-reassuring fetal heart rate monitoring; Assess amniotic fluid volume in post-term gestation. Prostate Cancer (V1.2023). Pregnant Women. 2018; 74(4):422-429. In brief: classifications in brief: Mirels' classification: metastatic disease in long bones and impending pathologic fracture. Reformatted Coding section. 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). Hepatogastroenterology. 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. There are currently more than 125 Treatment Centers around the world using Insightec's Exablate Neuro platform to treat Essential Tremor. 2015; 62(137):140-143. A total of 29 individuals underwent a follow-up biopsy, either at 12 months only, or at 12 and 36 months. Klotz L, Pavlovich CP, Chin J, et al. Rebillard X, Gelet A, Davin JL, et al. American College of Obstetricians and Gynecologists (ACOG). 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. Prenatal ultrasound-series. Focused ultrasound for the treatment of bone metastases: effectiveness and feasibility. The five HIFU trials included a total of only 136 individuals. 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.. Joo B, Park MS, Lee SH, et al. 2018; 51(4):463-469. Transrectal high-intensity focused ultrasound for treatment of patients with stage T1b-2n0m0 localized prostate cancer: a preliminary report. Renal mass and localized renal cancer: Evaluation, management, and follow-up: AUA guideline. There were no new reported serious AEs. 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. BJU Int. 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. 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. Evaluation of quality of life outcomes following palliative treatment of bone metastases with magnetic resonance-guided high intensity focused ultrasound: an international multicentre study. Required ultrasound or colonoscopy for select adult patients based on clinical scenario; Ultrasound-first approach for pediatric abdominal and pelvic pain . 2017; 197(1):97-102. 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. $0 virtual care, 24/7. Beerlage HP, van Leenders GJ, Oosterhof GO, et al. New 2020. This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for Ultrasound, Soft Tissues of Head and Neck. BJU Int. BJU Int. Real-time magnetic resonance-guided high-intensity focused ultrasound focal therapy for localised prostate cancer: preliminary experience. J Urol. 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. World J Gastroenterol. High-intensity focused ultrasound and localized prostate cancer: efficacy results from the European multicentric study. 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. 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. 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). Errico A. Cochrane Database Syst Rev. We are now accepting all Anthem Blue Cross Blue Shield patients. 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. Surgery: MRgFUS-non invasive treatment for patients with painful bone metastasis. Guideline for the management of clinically localized prostate cancer: 2007 update. 2010; 468(10):2825-2827. Available at: Antepartum Fetal surveillance. Palliative treatment: Treatment given for relief of symptoms and pain rather than attempting to cure. Uchida T, Tomonaga T, Kim H, et al. The authors reviewed 9 studies with a total of 167 participants. Salvage high-intensity focused ultrasound for patients with recurrent prostate cancer after brachytherapy. Eur Urol. 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. Pickles T, Goldenberg L, Steinhoff G. Technology review: high-intensity focused ultrasound for prostate cancer. Prostate Cancer. Approximately 98% of subjects received 1 (60%) or 2 treatments (38%). Participants included those who could not undergo or refused all other available options for pain palliation. When services are Not Medically Necessary:For the procedure and diagnosis codes listed above when criteria are not met. MPTAC review. FAQ 133, July 2021. Early prospective studies evaluating MRgFUS reported promising results. Contact us today for information about Anthem or for questions regarding Medicaid programs and coverage. You bet! To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the member's card. 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. Clarification to Not Medically Necessary Statement. Clin Genitourin Cancer. Birth Defects Homepage: Diagnosis. The primary endpoint was the proportion of individuals who achieved a 75% or greater reduction in PSA at 12 months post-procedure. Statement on Biological Effects of Ultrasound in Vivo. The American College of Obstetricians and Gynecologists (ACOG) 2018 Practice Bulletin Ultrasound in Pregnancy lists the following recommendations: The following conclusions are based on good and consistent evidence (Level A): The following conclusions are based on limited or inconsistent evidence (Level B): The following conclusion and recommendation are based primarily on consensus and expert opinion (Level C): The American College of Radiology (ACR), the American Institute of Ultrasound in Medicine (AIUM), ACOG, the Society for Maternal Fetal Medicine (SMFM), and the Society of Radiologists in Ultrasound (SRU) practice parameter (2018) notes: A standard obstetrical ultrasound examination in the first trimester includes evaluation of the presence, size, location, and number of gestational sac(s). Focal salvage therapy for localized prostate cancer recurrence after external beam radiotherapy: a pilot study. No. Whole-gland ablation of localized prostate cancer with high-intensity focused ultrasound: oncologic outcomes and morbidity in 1002 patients. Ultrasound imaging can be used after delivery to evaluate abnormalities of the reproductive and adjacent structures. 2009; 16(1):140-146. Available at. The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Updated Coding section with 10/01/2020 ICD-10-CM changes; added O99.891; removed Q51.20 deleted 09/30/2020. 2021; 205(3):769-779. For more information about your rights, look at the explanation of benefits you will receive for that medical claim. You should contact Anthem Blue Cross and Blue Shield directly to appeal denial of coverage for medical claims by calling 1855- -641-4862. Management of preterm labor. 2010; 468(10):2825-2827. The TULSA-PRO (Profound Medical Corp., Fort Myers, FL) received 510(k) clearance by the FDA in 2019. 2014; 65(5):907-914. 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). The current evidence is insufficient to support the use of HIFU as a generally accepted oncological treatment. 2007; 177(6):2106-2131. High intensity focused ultrasound ablation for patients with inoperable liver cancer. AIUM-ACR-ACOG-SMFM-SRU Practice parameter for the performance of standard diagnostic obstetric ultrasound examinations. Transurethral ultrasound ablation (TULSA), which delivers directional thermal ultrasound via a catheter inserted into the urethra, is specific to prostate cancer. 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. Transrectal high-intensity focused ultrasound: minimally invasive therapy of localized prostate cancer. 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. For appeals related to well-being incentive credits, Treatment of localized prostate cancer using high-intensity focused ultrasound. Cochrane Database Syst Rev. Rockville (MD): Agency for Healthcare Research and Quality (US); 2020 Sep. Report No. Summary of Safety and Effectiveness Data (SSED). The authors reported that salvage TULSA was technically feasible and showed encouraging early results but have not been compared to standard therapy. Urology. Reviewed and validity confirmed 2011. Government Agency, Medical Society, and Other Authoritative Publications: Maternal UltrasoundObstetricPrenatalSonography. Principles and results of high-intensity focused ultrasound for localized prostate cancer. It is likely that both of these treatment effects contribute to pain relief. Available at. 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 routine use of pulsed Doppler ultrasound to either document or listen to embryonic/fetal cardiac activity is discouraged. 2002; 59(3):394-398. Updated References section. Although use of HIFU or MRgFUS for primary prostate cancer or for prostate cancer metastatic to locations other than bone has not entered the generally accepted standard care for these conditions, treatment of pain related to prostate cancer metastatic to bone may provide benefits to affected men. The value of adding a universal booking scan to an existing protocol of routine mid-gestation ultrasound scan. 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). Committee Opinion 723. TULSA was developed as an alternative method of prostate tissue ablation. Urology. Focal high intensity focused ultrasound of unilateral localized prostate cancer: a prospective multicentric hemiablation study of 111 patients. Poggenpoel EJ, Geerts LT, Theron GB. In brief: classifications in brief: Mirels' classification: metastatic disease in long bones and impending pathologic fracture. An individual with out-of-field recurrence underwent a repeat salvage TULSA. Updated Coding section with additional diagnosis codes D25.0-D25.9, O26.872-O26.879, O99.210-O99.213, O99.810. Reaffirmed 2021. 2017. Updated Discussion/General Information, Coding and Reference sections. Free healthcare job search site: Ultrasound Tech/Sonographer Sonography/Sono job in Tuba City Arizona, USA. 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