Effectiveness of 12-13-week scan for early diagnosis of fetal congenital anomalies in the cell-free DNA era. We reserve the right to review and update Clinical UM Guidelines periodically. Pain palliation in patients with bone metastases using magnetic resonance-guided focused ultrasound with conformal bone system: a preliminary report. Reapproved June 16, 2020. Uddin Ahmed H, Cathcart P, Chalasani V, et al. Int J Gynaecol Obstet. 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. The anthem blue cross rehab coverage is depending on the location of the policyholder and the specifics of their plan. AIUM Practice Parameter for the Performance of Detailed Second- and Third-Trimester Diagnostic Obstetric Ultrasound Examinations. The primary endpoint was the proportion of individuals who achieved a 75% or greater reduction in PSA at 12 months post-procedure. The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. In 2015, The U.S. Food and Drug Administration (FDA) approved two devices for use in prostate cancer. 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. 2015; 10(2):e0118212. In the first phase III study published, Hurwitz and colleagues (2014) conducted a randomized, placebo-controlled, single-blind, multicenter, pivotal trial which included 147 participants with bone metastases from breast, prostate, kidney, lung or other primary tumors. 2020; 22:79-87. 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). Available at. Eur Urol. Klotz L, Pavlovich CP, Chin J, et al. Clarification to Not Medically Necessary Statement. 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. This document addresses ultrasound ablative therapy for the treatment of oncologic conditions. 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. 2017; 69(1):93-100. The mean follow-up period was 6.4 years (range, 0.2-13.9). For appeals related to well-being incentive credits, Ultrasound: A screening or diagnostic technique in which very high frequency sound waves are passed into the body, and the reflected echoes are detected and analyzed to build a picture of the internal organs or of a single fetus or multiple fetuses in the uterus. 2007; 177(6):2106-2131. Guideline for the management of clinically localized prostate cancer: 2007 update. Updated Coding section; corrected ICD-10 diagnosis code O41.00X0. Rombouts SJ, Vogel JA, van Santvoort HC, et al. We are now accepting all Anthem Blue Cross Blue Shield patients. Medical Policy & Technology Assessment Committee (MPTAC) review. No. 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 . 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. In addition, 21% of individuals in the MRgFUS group reduced their morphine equivalent daily dose (MEDD) intake and another 26% completely stopped their MEDD consumption. Bone metastasis: When cancer cells have broken off from the primary tumor and have settled and started growing on bones. Cochrane Database Syst Rev. Ultrasound examinations can be used to assess fetal anatomy, particularly neuroanatomy, and to monitor growth. 2014; 65(5):907-914. Available at: U.S. National Library of Medicine. In 2021, Nair and colleagues reported the 3-year outcomes of the participants in the Chin study. Participants received either MRgFUS (n=112) or placebo (n=35) treatment. 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. Updated Discussion and References section. Real-time magnetic resonance-guided high-intensity focused ultrasound focal therapy for localised prostate cancer: preliminary experience. 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). American Urological Association (AUA). MPTAC review. Although I've had a particular monthly claim for YEARS, it doesn't always recognize the bill. NOTE: Information about the cost of this plan (called the . To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the member's card. Alldred SK, Takwoingi Y, Guo B, et al. Br J Surg. CT, digital radiography, ultrasound, mammography and DEXA equipment at each of our outpatient centers. An abnormal finding on second-trimester ultrasonography that identifies a major congenital anomaly significantly increases the risk of genetic abnormality and warrants further counseling, including the discussion of various prenatal testing strategies. Removed ICD-9 codes from Coding section. There are currently more than 125 Treatment Centers around the world using Insightec's Exablate Neuro platform to treat Essential Tremor. Anthem BlueCross Coverage for: Individual + Family | Plan Type: HMO Anthem Value Ded HMO 750/25/40/25% The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Siddiqui KM, Billia M, Arifin A, et al. However, the change from baseline in MEDD intake was not statistically significant, although the authors noted a trend towards a statistically significant change. 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. 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,. ACR Appropriateness Criteria. BJU Int. Crouzet S, Blana A, Murat FJ, et al. See the following related document for HIFU treatment non-oncologic indications: For information regarding other palliative treatments of metastatic bone lesions, please see the following: Metastatic lesions located 1 centimeter (cm) or greater from skin and major nerve bundles; Individual does not present an increased risk of fracture from the procedure (for example, a score of 7 or less on Mirels fracture risk score); Individual does not require surgical stabilization or have clinically significant comorbidities; Individual is not a candidate for other therapies as evidenced by pain refractory to previous radiation therapy. Jawad MU, Scully SP. 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. Ultrasound, the use of low-intensity sound waves to produce images, is an established diagnostic tool. Cancer. 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. Early prospective studies evaluating MRgFUS reported promising results. Influence of high intensity focused ultrasound (HIFU) treatment to the pancreatic function in pancreatic cancer patients. No ionizing radiation (x-ray) is used in ultrasound imaging. Updated Description, Discussion, References and Websites for Additional Information sections. Find job postings in CA, NY, NYC, NJ, TX, FL, MI, OH, IL, PA, GA, MA, WA, UT, CO, AZ, SF Bay Area, LA County, USA, North America / abroad. 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 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. Results indicated that median survival in RFA, IRE and SBRT was more favorable compared to HIFU. Clin Orthop Relat Res. High-intensity focused ultrasound and localized prostate cancer: efficacy results from the European multicentric study. The use of TULSA has been evaluated in several prospective and retrospective studies, with participants being treated for whole gland or partial gland ablation and as primary or salvage treatment as well as combined therapy for individuals with prostate cancer (Elterman, 2021; Lumiani, 2021; Ramsay, 2017). 2018; 51(4):463-469. Find a doctor near you. J Urol. . Updated: June 16, 2022. 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). Available at: American Institute of Ultrasound in Medicine (AIUM). MR-guided focused ultrasound (MRgFUS) ablation for the treatment of nonspinal osteoid osteoma: a prospective multicenter evaluation. The mean reduction in the NRS score was significant between MRgFUS and placebo (3.6 3.1 versus 0.7 2.4). Following treatment, no residual tumor was found in 46.2% of cases. Shoji S, Nakano M, Nagata Y, et al. 2015; 56(2):503-509. Li CC, Wang YQ, Li YP, Li XL. Search doctors, conditions, or procedures . There's Still Time To Enroll $0 preventive care. Salvage radical prostatectomy following primary high intensity focused ultrasound for treatment of prostate cancer. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. Zika virus was first reported in South America in May 2015 and since that time has now appeared in the United States. High intensity focused ultrasound (HIFU): A surgical procedure that uses focused high energy sound waves to destroy target tissues in the body. Focal therapies are proposed as less invasive treatment options when compared to radical prostatectomy or radiation therapy. In brief: classifications in brief: Mirels' classification: metastatic disease in long bones and impending pathologic fracture. Relief of lower urinary tract symptoms after MRI-guided transurethral ultrasound ablation for localized prostate cancer: subgroup analyses in patients with concurrent cancer and benign prostatic hyperplasia. Yonsei Med J. Lumiani A, Samun D, Sroka R, Muschter R. Single center retrospective analysis of fifty-two prostate cancer patients with customized MR-guided transurethral ultrasound ablation (TULSA). Pak J Pharm Sci. Mol Urol. Providers are responsible for billing the appropriate CPT code, modifier, and diagnosis combinations. Lancet Oncol. Blana A, Murat FJ, Walter B, et al. 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. Our radiologists are among the most . Last Revised March 16, 2022. Joo B, Park MS, Lee SH, et al. The authors noted that incomplete tumor ablation could be related to poor accuracy in determining the target area or movement during the procedure. The maternal cervix and adnexa should be examined. Chin JL, Billia M, Relle J, et al. We reserve the right to review and update Clinical UM Guidelines periodically. 2008; 38(3):192-199. 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). Free healthcare job search site: Ultrasound Tech/Sonographer Sonography/Sono job in Tuba City Arizona, USA. Committee Opinion 723. Pain severity was further reduced at the 3-month follow-up to 1 (SD 1.1) (0-3; 95% CI, 0-1.85) (p=0.001). Zika Virus. Rejection notice to me (if I'm lucky) and I start over. Poggenpoel EJ, Geerts LT, Theron GB. Rooms for rent in Bury flat and house shares - 3 currently available. Non-Contact Ultrasound Treatment for Wounds; Non-Oncologic Uses of Rituximab (Rituxan) Nutritional Treatment of Childhood Medical Conditions; Ophthalmologic Techniques for Evaluating Glaucoma; Optical Diagnostic Devices for Evaluating Skin Lesions Suspected of Malignancy ; Oral Lesion Identification System (ViziLite, Velscope) Moved content of MED.00119 High Intensity Focused Ultrasound (HIFU) for Oncologic Indications to new clinical utilization management guideline document with the same title. Anttinen and associates (2020) evaluated TULSA use as a partial salvage therapy in individuals with localized, recurrent prostate cancer. Available at: Testing for Zika Virus Infections. 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. The current evidence does not show that clinical outcomes of those undergoing TULSA is similar to those undergoing established alternatives. The study also included a crossover component; 17 of the 23 individuals in the placebo group who did not complete follow-up chose to receive rescue MRgFUS after a lack of response to placebo. J Ther Ultrasound. Ultrasound examinations can be used to assess fetal anatomy, particularly neuroanatomy, and to monitor growth. 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 . For more information about your rights, look at the explanation of benefits you will receive for that medical claim. The PSA level, which had dropped following treatment, remained low. 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 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. 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). Focal therapy for localized prostate cancer: a phase I/II trial. The value of adding a universal booking scan to an existing protocol of routine mid-gestation ultrasound scan. First trimester ultrasound tests alone or in combination with first trimester serum tests for Down's syndrome screening. The recommendations are based on limited data. Hurwitz MD, Ghanouni P, Kanaev SV, et al. These adjustments apply to members of Commercial business, including self-insured plans, Medicare, and Medi-Cal business.
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