anthem ultrasound coverage

2018; 30(4):233-242. 2017; 69(1):93-100. However, the change from baseline in MEDD intake was not statistically significant, although the authors noted a trend towards a statistically significant change. Although I've had a particular monthly claim for YEARS, it doesn't always recognize the bill. 2007; 177(6):2106-2131. Bone metastasesWhen services may be Medically Necessary when criteria are met: Unlisted procedure, musculoskeletal system, general [when specified as high intensity focused ultrasound ablation for pain palliation for bone metastases], Focused ultrasound ablation/therapeutic intervention, other than uterine leiomyomata, with magnetic resonance (MR) guidance. Available at: Dahm P, Brasure M, Ester E, et al. Evaluation of quality of life outcomes following palliative treatment of bone metastases with magnetic resonance-guided high intensity focused ultrasound: an international multicentre study. The clearance was based upon the Ablatherm device as the predicate device. 1000s more rooms to let in Bury, West Sussex and across the UK at SpareRoom.co.uk - the UK's #1 flatshare site. Updated Coding section with 10/01/2018 ICD-10-CM diagnosis code changes; added Q51.20-Q51.28, Z20.821. Napoli A, Anzidei M, De Nunzio C, et al. 2002; 59(3):394-398. BJU Int. AIUM Practice Parameter for the Performance of Detailed Second- and Third-Trimester Diagnostic Obstetric Ultrasound Examinations. Ahmed HU, Freeman A, Kirkham A, et al. This document addresses the use of maternity ultrasound in the outpatient setting. Improved outcomes with advancements in high intensity focused ultrasound devices for the treatment of localized prostate cancer. Added not medically necessary statement for TULSA. 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). 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. In brief: classifications in brief: Mirels' classification: metastatic disease in long bones and impending pathologic fracture. Providers are responsible for billing the appropriate CPT code, modifier, and diagnosis combinations. Revised 2020. The majority of attributable AEs were grade 1 or 2. Thuroff S, Chaussy C, Vallancien G, et al. Mirels scoring system: A scoring system based upon lesion characteristics and pain levels used to classify pathologic fracture risk. Federal and State law, as well as contract language, and Medical Policy take precedence over Clinical UM Guidelines. Revised May 20, 2020. Available at: Second and third trimester screening for fetal anomaly. MPTAC review. To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the member's card. The difference in response rates between MRgFUS and placebo at 3 months was significant (64.3% versus 20.0%). 2015; 28(3 Suppl):1097-1100. Poggenpoel EJ, Geerts LT, Theron GB. Gelet A, Chapelon JY, Poissonnier L, et al. Uchida T, Ohkusa H, Nagata Y, et al. Pregnant Women. High-intensity focused ultrasound for the treatment of localized prostate cancer: 5-year experience. 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.. But in general, know that most plans cover: STD testing; Rh incompatibility testing; Prenatal vitamins; Gestational diabetes testing; Breastfeeding counseling and equipment; Post-birth birth control; Birth; Medical coverage of any complications; Dependent Care Accounts Post-treatment biopsies were available in 77% of subjects. American College of Radiology (ACR). 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. The single-arm, prospective, multi-center pivotal trial, TULSA-PRO Ablation Clinical Trial (TACT), enrolled 115 individuals with intermediate risk (67.0%) or low risk (33.0%) organ confined prostate cancer who underwent whole gland prostate ablation (Klotz, 2021). While the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines (CPG) in Oncology for Adult Cancer Pain (V2.2022) document notes that the palliative effects of HIFU have been demonstrated in several small studies, no recommendation for or against the use of HIFU for pain palliation was given. A set of individuals who were positive for insignificant disease at 12 months (n=4) or clinically significant disease at 12 months (n=5) required salvage treatment. Peek and associates (2015) conducted a systematic review of the use of HIFU in breast cancer. No ionizing radiation (x-ray) is used in ultrasound imaging. Placenta Accreta Spectrum. 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. No. 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. Prostate Cancer Prostatic Dis. November 6, 2015. HIFU therapy was included in a comparative effectiveness review of clinically localized prostate cancer treatments (Dahm, 2020). . Medical Encyclopedia. Updated Coding section with 10/01/2020 ICD-10-CM changes; added O99.891; removed Q51.20 deleted 09/30/2020. Rejection notice to me (if I'm lucky) and I start over. Muto S, Yoshii T, Saito K, et al. 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 The new Multiple Delivery policy has the same . 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). One ultrasound of a pregnant uterus per member, per routine course of care; Estimate gestational age for individuals with uncertain clinical dates. However, comparisons involving HIFU were limited to radical prostatectomy because of a lack of studies comparing HIFU to other therapies. The authors concluded, Although newer modalities hold promise, we need higher quality studies to assess patient important outcomes to guide evidence-based clinical practice.. Federal and State law, as well as contract language, and Medical Policy take precedence over Clinical UM Guidelines. 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. According to the FDA labeling, a nonunion is considered to be established when the fracture site shows no visibly progressive signs of healing. The feasibility and safety of high-intensity focused ultrasound as salvage therapy for recurrent prostate cancer following external beam radiotherapy. Eur Urol. Updated Discussion/General Information and Reference sections. These results were not included in the primary efficacy analysis. MedlinePlus. : 20-EHC022. Zika virus was first reported in South America in May 2015 and since that time has now appeared in the United States. A statistically significant pain response was reported in 70.7% of this group. Late complications included occurrences of stenosis (9%) and fistula (0.4%). Anthem Blue Cross and Blue Shield - BlueAdvantage POS Colorado Higher Education Insurance Benefits Alliance Trust Coverage for: Individual + Family | Plan Type: HMO . 2011; 108(8 Pt 2):E196-E201. Individuals received either whole gland (n=8) or partial (n=8) ablation. Twelve-month prostate volume reduction after MRI-guided transurethral ultrasound ablation of the prostate. grievance or appeal. 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. Quality of life following high-intensity focused ultrasound for the treatment of localized prostate cancer: a prospective study. Indiana Medicaid. Reformatted Coding section and updated with 01/01/2021 CPT and HCPCS changes, added 55880 to replace NOC code; code C9747 deleted 12/31/2020. November 17, 2019. Of note, 65.7% (23/35) of individuals in the placebo group did not complete the 3-month follow-up compared to approximately 21% (26/112) of the MRgFUS group. ACOG Practice Bulletin Number 171. There were no treatment-related AEs. Contact us today for information about Anthem or for questions regarding Medicaid programs and coverage. The identified primary endpoint was the improvement in self-reported pain score without an increase in pain medication utilization at 3 months. For more information about your rights, look at the explanation of benefits you will receive for that medical claim. 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. Rebillard X, Gelet A, Davin JL, et al. Available at. Eur Urol Open Sci. 2020; 22:79-87. Clin Genitourin Cancer. First trimester ultrasound tests alone or in combination with first trimester serum tests for Down's syndrome screening. Ultrasound Obstet Gynecol. Liberman and associates (2009) used MRgFUS to treat 31 individuals with painful bone metastases who had exhausted or refused all other pain palliation methods. NCCN Clinical Practice Guidelines in Oncology. HIFU is a non-invasive ablative procedure which has the advantage of sparing surrounding tissue which may reduce postoperative morbidity and hasten recovery. Practice Advisory Interim Guidance for Care of Obstetric Patients During a Zika Virus Outbreak. MPTAC review. Zika Virus. However, residual tumors of less than 10% were found in 29.4% of cases and residual tumors between 10-90% were found in 22.7% of cases. The TULSA-PRO (Profound Medical Corp., Fort Myers, FL) received 510(k) clearance by the FDA in 2019. Minerva Urol Nefrol. 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. MPTAC review. TULSA has been proposed as a localized treatment of unilateral intermediate risk prostate cancers in individuals not interested in active surveillance (Klotz, 2021). Can J Urol. 2012; 118(12):3071-3078. Eur Urol. Recommendations for the management of a pregnant individuals with suspected Zika virus infection include: The 2021 CDC guideline on the treatment of sexually transmitted infections includes management recommendations for individuals who are diagnosed with text in the second half of pregnancy. 2015; 193(1):103-110. In addition, there are limitations on tissue tolerance at sites previously irradiated. Primary pain palliation and local tumor control in bone metastases treated with magnetic resonance-guided focused ultrasound. HIFU treatment is combined with a visualization method, frequently MR guidance, to better guide treatment in real time. Updated Coding section to add ICD-10-CM diagnosis codes O09.00-O09.03, O09.811-O09.829. 2004; 63(4):625-629. J Urol. Sonablate was classified as a class II device. Transrectal high-intensity focused ultrasound: minimally invasive therapy of localized prostate cancer. Available at: Magnetic Resonance guided Focused Ultrasound Surgery System (MRgFUS) ExAblate Model 2000/2100. Available at: Centers for Disease Control and Prevention (CDC). 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. 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. In addition to five HIFU trials, the review included radiofrequency ablation (RFA), irreversible electroporation (IRE), stereotactic body radiation therapy (SBRT), iodine-125, iodine-125cryosurgery, photodynamic therapy and microwave ablation. The five HIFU trials included a total of only 136 individuals. 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 . 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. In the 25 participants that were able to tolerate a complete treatment, 72% (18/25) reported significant pain reduction of at least 2 points on the VAS scale, 24% (6/25) reported no reduction in pain and 4% (1/25) reported an increase in pain levels. American College of Obstetricians and Gynecologists (ACOG). When services are Not Medically Necessary:For the procedure and diagnosis codes listed above when criteria are not met. Bertrand AS, Iannessi A, Natale R, et al. Klotz L, Pavlovich CP, Chin J, et al. Focal therapies are proposed as less invasive treatment options when compared to radical prostatectomy or radiation therapy. Br J Surg. 399 reviews of Anthem Blue Cross "Poor reviews for Anthem's medical insurance coverage business, in particular, the medical insurance processing. Transurethral ultrasound ablation (TULSA), which delivers directional thermal ultrasound via a catheter inserted into the urethra, is specific to prostate cancer. Although the exact mechanism of analgesic action of MRgFUS in pain palliation is unknown, studies have pointed to a few explanations. Our radiologists are among the most . Accessed on September 13, 2022. ACR Appropriateness Criteria. Focal therapy for localised unifocal and multifocal prostate cancer: a prospective development study. The current standard treatment is external beam radiation therapy (EBRT). J Endourol. The recommendations are based on limited data. Principles and results of high-intensity focused ultrasound for localized prostate cancer. December 2016. After excluding the drop-out groups the results remained similarly statistically significant. 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 anthem blue cross rehab coverage is depending on the location of the policyholder and the specifics of their plan. (i.e. 2012; 105(2):198-202. Cochrane Database Syst Rev. J Urol. ACOG Practice Bulletin 175. Prudent use and safety diagnostic ultrasound in pregnancy. 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. Eur Radiol. There was 1 in-field and 2 out-of-field recurrences reported at that time. It is completely automated and therefore extremely rigid. Chaussy C, Thuroff S. Results and side effects of high-intensity focused ultrasound in localized prostate cancer. Low-Intensity Pulsed Ultrasound for Fracture Nonunion. 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. Alldred SK, Takwoingi Y, Guo B, 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. Hoosier Healthwise. Boccon-Gibod L, Djavan WB, Hammerer P, et al. (2018). J Bone Joint Surg Am. 2015; 102(3):182-193. Shah TT, Peters M, Kanthabalan A, et al. 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. There were 12 grade 3 adverse events (AEs) attributable to the TULSA-PRO, all of which were resolved by 12 months. 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. J Urol. Assess vaginal bleeding of undetermined etiology; Assess abdominal or pelvic pain of undetermined etiology; Evaluation of fetal condition in late registrants for prenatal care; History of unexplained fetal demise in a previous pregnancy; Assess the fetus in cases with maternal risk factors such as family history of congenital abnormalities, chronic systemic disease (including but not limited to, hypertension, diabetes or sickle cell disease), preeclampsia, substance abuse or hyperemesis gravidarum; Assessment of fetus after abnormal serum Alpha Fetal Protein (AFP), serum screen or multiple analyte serum screen, or cell-free fetal deoxyribonucleic acid (DNA) screening for aneuploidy; Suspected ectopic pregnancy or hydatidiform mole, and to follow hydatidiform mole; Assess the fetus in cases of Rhesus (Rh) isoimmunization and other causes of fetal hydrops; Provide guidance for other testing, such as amniocentesis, chorionic villus sampling, and cordocentesis or procedures such as intrauterine blood transfusions or other in-utero fetal therapeutic procedures. Under the benefits of certain plans, the following diagnostic imaging services that are received in an outpatient setting, such as in a medical office, the outpatient department of a hospital or at a freestanding imaging center may require prior approval (for dates of service on or after February 15, 2007 for Blue Cross NC commercial plans and September 1, 2010 for Blue Medicare HMO and Blue . The doctors in the emergency room did multiple tests including a CT scan and ultrasound. 2015; 62(137):140-143. 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. Added Websites for Additional Information section. 2014; 20(28):9570-9577. Available at: Centers for Disease Control and Prevention (CDC): How is Prostate Cancer Treated? Nat Rev Clin Oncol. Rischmann P, Gelet A, Riche B, et al. 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. This study was defined by the regulatory agency to evaluate the effectiveness of the device to ablate prostate tissue. 2016; 70(3):447-455. 2001; 15(4):437-440. 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). 2014; 106(5). 2014; 114(4):532-540. J Endourol. Shoji S, Nakano M, Nagata Y, et al. * From Jawad MU, Scully SP. MPTAC review. MPTAC review. Removed ICD-9 codes from Coding section. Influence of high intensity focused ultrasound (HIFU) treatment to the pancreatic function in pancreatic cancer patients. 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. Reviewed and validity confirmed 2011. U.S. Food and Drug Administration (FDA). At 12 months, the majority of participants (10/11) were cancer free in the ablated area and maintained a low stable PSA. Chen L, Wang K, Chen Z, et al. American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal Fetal Medicine (SMFM). The following codes for treatments and procedures applicable to this guideline are included below for informational purposes. Bone Metastases. 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. 510K Premarket notification. Approved May 19, 2020. Blana A, Murat FJ, Walter B, et al. The prospective, nonrandomized, investigator-initiated, single-arm, single-center phase 1 study included 11 individuals with localized, histopathologically verified, radio-recurrent prostate cancer. 2018. Eur Urol. Adverse events included grade 1 or 2 hematuria, urinary tract infections or acute urinary retention, and grade 3 epididymitis. List Your Practice ; Search . Coverage varies some from plan to plan, so check your plan's specifics. Please enter a valid 5-digit Zip Code. There were no reported treatment related severe adverse events (AEs). Studies have pointed to a few explanations which has the advantage of sparing surrounding which. Hcpcs changes, added 55880 to replace NOC code ; code C9747 deleted.. Influence of high intensity focused ultrasound as salvage therapy for recurrent prostate cancer: 5-year experience Nakano,. Murat FJ, Walter B, et al zika virus Outbreak a low stable.! 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