Cochrane Database Syst Rev. These studies have a number of methodological limitations, including a lack of randomization of participants, a lack of a comparator group and limited follow-up for oncologic outcomes. Updated Discussion/General Information, Coding and Reference sections. TULSA is considered not medically necessary for any indication, including but not limited to prostate cancer. J Urol. The primary endpoint was achieved in 96% (110/115) of participants. CPT codes Dx codes 76801 76802 D25, D25.0, D25.1, D25.2, D25.9, O0900, O0901, O0902, O0903, O09511, O09512, Available at: Dahm P, Brasure M, Ester E, et al. Number 7. . 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. In Ohio: Community Insurance Company. Nair SM, Hatiboglu G, Relle J, et al. 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. TULSA was developed as an alternative method of prostate tissue ablation. J Ultrasound Med 2013; 32(6):1083-1101. Anthem - Blue Cross Blue Shield Long awaited and much anticipated? 2012; 116(3):201-205. After excluding the drop-out groups the results remained similarly statistically significant. J Urol. . Primary pain palliation and local tumor control in bone metastases treated with magnetic resonance-guided focused ultrasound. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. There's Still Time To Enroll $0 preventive care. Yutkin V, Ahmed HU, Donaldson I, et al. Bonekamp D, Wolf MB, Roethke MC, et al. 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). Can J Urol. 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 . Available at: American Institute of Ultrasound in Medicine (AIUM). 15727 Anthem Pkwy, Suite 600 . Available at: U.S. National Library of Medicine. Salvage high-intensity focused ultrasound (HIFU) for locally recurrent prostate cancer after failed radiation therapy: Multi-institutional analysis of 418 patients. Errico A. Ultrasound in pregnancy. High-intensity focused ultrasound (HIFU) followed after one to two weeks by radical retropubic prostatectomy: results of a prospective study. Rejection notice to me (if I'm lucky) and I start over. 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,. Updated Coding section to include ICD-10-CM diagnosis codes Z36.0-Z36.9. Uchida T, Sanghvi NT, Gardner TA, et al. ACOG Practice Bulletin Number 171. 2010; 468(10):2825-2827. 2014; 84(5):1157-1162. Ultrasound Tech in San Antonio, Texas, United States. Cancer. 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). The authors noted that incomplete tumor ablation could be related to poor accuracy in determining the target area or movement during the procedure. Thuroff S, Chaussy C. High-intensity focused ultrasound: complications and adverse events. Federal and State law, as well as contract language, and Medical Policy take precedence over Clinical UM Guidelines. 2005; 4(3):187-192. HIFU or MRgFUS has also been studied as a potential treatment of various cancers. Eur Urol. The uterus, cervix, adnexa, and cul-de-sac region should be examined. Br J Surg. Lawrentschuk N, Finelli A, Van der Kwast TH, et al. Palliative treatment: Treatment given for relief of symptoms and pain rather than attempting to cure. AIUM practice guideline for the performance of obstetric ultrasound examinations. A clinically significant biopsy was reported in 34% (10/29) of participants with 59% (17/29) of participants reporting any positive biopsy. The authors noted these results compared well to the radiation therapy complication rate. BJU Int. Chaussy C, Thuroff S. Results and side effects of high-intensity focused ultrasound in localized prostate cancer. Urology. Due to variances in utilization patterns, each plan may choose whether to adopt a particular Clinical UM Guideline. The authors concluded, Although newer modalities hold promise, we need higher quality studies to assess patient important outcomes to guide evidence-based clinical practice.. *Coverage includes fertility preservation . 2022 Prenatal ultrasound diagnosis (Dx) codes Please note that this information is a guideline. Ganzer R, Robertson CN, Ward JF, et al. 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. 2009; 16(1):140-146. Added medically necessary indication when there is a known or suspected exposure to the Zika virus to the Clinical Indications section. Ultrasound examinations can be used to assess fetal anatomy, particularly neuroanatomy, and to monitor growth. Updated Coding section with additional diagnosis codes D25.0-D25.9, O26.872-O26.879, O99.210-O99.213, O99.810. Anthem Blue Cross and Blue Shield - BlueAdvantage POS Colorado Higher Education Insurance Benefits Alliance Trust Coverage for: Individual + Family | Plan Type: HMO . For appeals related to well-being incentive credits, Sexually Transmitted Infections Treatment Guidelines, 2021. 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. NOTE: Information about the cost of this plan (called the premium) will be . High-intensity focused ultrasound for the treatment of localized prostate cancer: 5-year experience. J Urol. The resulting heat and cavitation destroys the targeted tissue. New reimbursement policy: Maternity Services and Multiple Delivery (Professional) Beginning with dates of service on or after December 1, 2019, Anthem's current Routine Obstetrics policy will be retired and will be replaced by the new Maternity Services policy and the new Multiple Delivery policy. Anthem has stopped covering patients in nine states 1 for MRI and CT scans performed in hospital outpatient settings - unless the exam qualifies for an "exception." On Nov. 15, Anthem will start retroactive reviews of MRI and/or CT services done in emergency departments in Missouri, Ohio and Kentucky. Available at: Second and Third Trimester Vaginal Bleeding. Prostate cancer is the second leading cause of death with approximately 39,430 deaths in 2018 (Bekelman, 2018). 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. Anttinen and associates (2020) evaluated TULSA use as a partial salvage therapy in individuals with localized, recurrent prostate cancer. Updated Description, Discussion, References and Websites for Additional Information sections. October 2016. . Uchida T, Tomonaga T, Kim H, et al. Updated Discussion/General Information and Reference sections. Late complications included occurrences of stenosis (9%) and fistula (0.4%). 2006a; 13(3):228-233. First analysis of the long-term results with transrectal HIFU in patients with localised prostate cancer. The recommendations are based on limited data. These Medical Policies serve as guidelines for health care benefit coverage decisions, which may vary according to the different products and benefit plans offered by BCBSIL. Hemi salvage high-intensity focused ultrasound (HIFU) in unilateral radiorecurrent prostate cancer: a prospective two-centre study. 1999b; 39(1):41-46. A total of 29 individuals underwent a follow-up biopsy, either at 12 months only, or at 12 and 36 months. Radiother Oncol. Guillaumier S, Peters M, Arya M, et al. Invest Radiol. Poggenpoel EJ, Geerts LT, Theron GB. Improved outcomes with advancements in high intensity focused ultrasound devices for the treatment of localized prostate cancer. Chaussy C, Thuroff S, Rebillard X, Gelet A. Subtle second-trimester ultrasound markers should be interpreted in the context of a background risk based on the patients age, history, genetic screening, and serum screening results. 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 . Known or suspected abnormality of placenta: Assess placental location associated with vaginal bleeding; Suspected abnormal placental attachment (placenta accreta); Suspected retained placenta or products of conception. 2017; 71(2):267-273. HIFU has been proposed as a treatment for multiple oncologic conditions. 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. Available at: Limited obstetrical ultrasound examination. The SBC shows you how you and the plan would share the cost for covered health care services. High intensity focused ultrasound ablation for patients with inoperable liver cancer. MedlinePlus. Crouzet S, Chapelon JY, Rouvire O, et al. Medical Policy & Technology Assessment Committee (MPTAC) review. 2015; 2015(7):CD007058. Mirels scoring system: A scoring system based upon lesion characteristics and pain levels used to classify pathologic fracture risk. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. Government Agency, Medical Society, and Other Authoritative Publications: Maternal UltrasoundObstetricPrenatalSonography. J Urol. Practice Advisory Interim Guidance for Care of Obstetric Patients During a Zika Virus Outbreak. 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. The study has several methodological flaws, including lack of a comparison group, and uncertainty regarding the percentage of subjects who completed the follow-up period. Prostate Cancer Prostatic Dis. Joo B, Park MS, Lee SH, et al. Ultrasound averages range from $54 to $100. Available at. Management of prostate-specific antigen relapse in prostate cancer: a European Consensus. Hoosier Healthwise. Bone metastasis: When cancer cells have broken off from the primary tumor and have settled and started growing on bones. Approved May 19, 2020. 2016; 70(3):447-455. One of the largest of these studies was conducted by Ganzer and colleagues (2011). 2015; 2015(6):CD001451. Ultrasound imaging can be used after delivery to evaluate abnormalities of the reproductive and adjacent structures. MPTAC review. 2003; 17(8):673-677. 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. For any of the diagnosis codes listed below for abnormalities and high-risk conditions, and including the following: Encounter for supervision of normal pregnancy [codes 76801, 76805, when criteria are met], Encounter for antenatal screening of mother, When services may be Medically Necessary when criteria are met for known or suspected abnormality of maternal reproductive structure, fetus, or placenta, or fetal viability or other high-risk conditions:For the procedure codes listed above for the following diagnoses, Incomplete spontaneous abortion without complication, Complete or unspecified spontaneous abortion without complication, Failed attempted termination of pregnancy without complication, Supervision of pregnancy with history of infertility, Supervision of pregnancy with history of ectopic pregnancy, Supervision of pregnancy with history of molar pregnancy, Supervision of pregnancy with history of pre-term labor, Supervision of pregnancy with other poor reproductive or obstetric history, Supervision of pregnancy with insufficient antenatal care, Supervision of elderly primigravida and multigravida, Supervision of other or unspecified high risk pregnancy, Pre-existing essential hypertension complicating pregnancy, Pre-existing hypertensive heart disease complicating pregnancy, Pre-existing hypertensive chronic kidney disease complicating pregnancy, Pre-existing hypertensive heart and chronic kidney disease complicating pregnancy, Pre-existing secondary hypertension complicating pregnancy, Unspecified pre-existing hypertension complicating pregnancy, Pre-existing hypertension with pre-eclampsia; first, second or third trimester, Pre-existing hypertension with pre-eclampsia; unspecified trimester, Mild to moderate pre-eclampsia; unspecified, second or third trimester, Severe pre-eclampsia; unspecified, second or third trimester, HELLP syndrome; unspecified, second or third trimester, Unspecified pre-eclampsia; unspecified, second or third trimester, Unspecified maternal hypertension; first, second or third trimester, Unspecified maternal hypertension; unspecified trimester, Pre-existing diabetes mellitus, type 1, in pregnancy, Pre-existing diabetes mellitus, type 2, in pregnancy, Unspecified pre-existing diabetes mellitus in pregnancy, Gestational diabetes mellitus in pregnancy, Other pre-existing diabetes mellitus in pregnancy, Unspecified diabetes mellitus in pregnancy, Pregnancy care for patient with recurrent pregnancy loss, Retained intrauterine contraceptive device in pregnancy, Uterine size-date discrepancy complicating pregnancy, Complications specific to multiple gestation, Maternal care for malpresentation of fetus, Maternal care for abnormality of pelvic organs, Maternal care for known or suspected fetal abnormality and damage, Maternal care for known or suspected poor fetal growth, Maternal care for viable fetus in abdominal pregnancy, Pregnancy with inconclusive fetal viability, Maternal care for abnormalities of the fetal heart rate or rhythm, Maternal care for other specified fetal problems, Maternal care for fetal problem, unspecified, Other disorders of amniotic fluid and membranes, Fetus-to-fetus placental transfusion syndrome, Morbidly adherent placenta, other/unspecified placental disorder, Premature separation of placenta (abruptio placentae), Retained placenta and membranes, without hemorrhage, Abnormality in fetal heart rate and rhythm complicating labor and delivery, Other specified diseases and conditions complicating pregnancy, Contact with and (suspected) exposure to Zika virus. For pregnant women with laboratory evidence of Zika infection, ultrasound to evaluate for fetal abnormalities consistent with congenital Zika virus syndrome is recommended. Pregnant Women. Rebillard X, Gelet A, Davin JL, et al. 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. Update date: March 4, 2022. The SBC shows you how you and the plan would share the cost for covered health care services. 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. In 2013, Napoli and colleagues treated 18 individuals with painful bone metastases with MRgFUS. Mol Urol. Prenatal ultrasound-series. Eur Radiol. The American Urological Association (AUA) 2007 guideline on prostate cancer notes that conclusions on the outcomes of HIFU cannot be determined as there is minimal data available on this treatment. The identified primary endpoint was the improvement in self-reported pain score without an increase in pain medication utilization at 3 months. Centers for Disease Control and Prevention (CDC). (2018). The benefits and limitations of ultrasonography should be discussed with all patients. check_circle Item Saved! American College of Obstetricians and Gynecologists (ACOG). 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. 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 . Anthem Blue Cross Blue Shield: Health Insurance, Medicare & More Learn more about your coverage options after the Public Health Emergency (PHE) ends. Eur Urology. ACR Appropriateness Criteria. 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. Reformatted Coding section. 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