anthem ultrasound coverage

Radiother Oncol. That coverage comes at a cost, however; specifically, Plan F is the most expensive of all the MedSup policies on the market today. Ultrasound Tech in San Antonio, Texas, United States. Joo B, Park MS, Lee SH, et al. MPTAC review. Zika virus was first reported in South America in May 2015 and since that time has now appeared in the United States. First trimester ultrasound tests alone or in combination with first trimester serum tests for Down's syndrome screening. Int J Urol. Although the exact mechanism of analgesic action of MRgFUS in pain palliation is unknown, studies have pointed to a few explanations. 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. Updated Coding section with 10/01/2022 ICD-10-CM changes; added O35.00X0-O35.9XX9 replacing O35.0XX0-O35.9XX9. No. The authors noted that incomplete tumor ablation could be related to poor accuracy in determining the target area or movement during the procedure. Accessed on September 13, 2022. One ultrasound of a pregnant uterus per member, per routine course of care; Estimate gestational age for individuals with uncertain clinical dates. Ultrasound during pregnancy is used to assess the uterus, umbilical cord and placenta, as well as fetal anatomy and well-being. 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 Updated Coding section with 10/01/2018 ICD-10-CM diagnosis code changes; added Q51.20-Q51.28, Z20.821. Pregnant Women. Prostate Cancer (V1.2023). Bone pain is a common complaint for individuals with metastatic cancer to the bone. Ideally the ultrasound is done at the same appointment as the screening mammogram. Updated Coding section with additional diagnosis codes D25.0-D25.9, O26.872-O26.879, O99.210-O99.213, O99.810. Prostate Cancer. High-intensity focused ultrasound in the treatment of primary prostate cancer: the first UK series. Available at: Second and third trimester screening for fetal anomaly. Transrectal high-intensity focused ultrasound: minimally invasive therapy of localized prostate cancer. A total of 22 individuals participated in the follow-up. Crouzet S, Blana A, Murat FJ, et al. In 2015, The U.S. Food and Drug Administration (FDA) approved two devices for use in prostate cancer. Int J Gynaecol Obstet. 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. Urology. Retroperitoneal ultrasound (US) studies represent the ultrasonic imaging of retroperitoneal organs for the diagnosis and management of abnormalities that occur within the retroperitoneum. July 25, 2018. The SBC shows you how you and the These options carry their own risks and side effects. High intensity focused ultrasound ablation for patients with inoperable liver cancer. 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). August 15, 2019. List Your Practice ; Search . In a prospective, non-randomized single arm trial, MRgFUS was used on 5 individuals with painful bone metastatic lesions with a pain rating of 4 or higher. Geiger D, Napoli A, Conchiglia A, et al. Temperatures within the targeted area increase to 60-95C, which destroys the targeted tissue without damaging the adjacent tissue. Screening for Fetal Aneuploidy. MPTAC review. 2015; 28(3 Suppl):1097-1100. 2017; 197(1):97-102. Nat Clin Pract Urol. Colombel M, Gelet A. 2015; 2015(7):CD007058. 2017; 3:CD012600. 2015; 10(2):e0118212. Please enter a valid 5-digit Zip Code. Routine ultrasound in late pregnancy (after 24 weeks' gestation). 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. Therapies for clinically localized prostate cancer [Internet]. 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. HIP Maternity will cover enhanced benefits . A total of 29 individuals underwent a follow-up biopsy, either at 12 months only, or at 12 and 36 months. The PSA decreased from a median of 6.26 to 0.53 at 12 months. Curr Urol Rep. 2003; 4(3):248-252. In some states, insurance must cover . 2021; 35(4):497-505. HIFU treatment is combined with a visualization method, frequently MR guidance, to better guide treatment in real time. Government Agency, Medical Society, and Other Authoritative Publications: The use of specific product names is illustrative only. Poggenpoel EJ, Geerts LT, Theron GB. Clin Orthop Relat Res. Updated Coding section to add ICD-10-CM diagnosis codes O09.00-O09.03, O09.811-O09.829. CPT codes Dx codes 76801 76802 D25, D25.0, D25.1, D25.2, D25.9, O0900, O0901, O0902, O0903, O09511, O09512, Chin JL, Billia M, Relle J, et al. Reviewed and validity confirmed 2011. ACOG Practice Bulletin 163. Bertrand AS, Iannessi A, Natale R, et al. Magnetic resonance imaging-guided transurethral ultrasound ablation in patients with localised prostate cancer: 3-year outcomes of a prospective Phase I study. In those individuals who reported a decrease in pain levels, 50% (9/18) reported complete relief of pain, with 52% reporting significant pain relief beginning 3 days post treatment. Ultrasound imaging can be used after delivery to evaluate abnormalities of the reproductive and adjacent structures. Ahmed HU, Freeman A, Kirkham A, et al. 510K Premarket notification. 2014; 114(4):532-540. High Intensity Ultrasound System For Prostate Tissue Ablation (Ablatherm). The most relevant clinical information is obtained when serial exams are done at least three weeks apart, beginning no earlier than 18 weeks gestation. The following codes for treatments and procedures applicable to this guideline are included below for informational purposes. A multicentre study of 5-year outcomes following focal therapy in treating clinically significant nonmetastatic prostate cancer. BJU Int. Bone Metastases. 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. Urology. Urol Oncol. Available at: Centers for Disease Control and Prevention (CDC): How is Prostate Cancer Treated? There were no treatment-related AEs. 2016; 47(4):530-532. Treatment of localized prostate cancer using high-intensity focused ultrasound. 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. Step 1: Report your pregnancy to your health plan. First clinical experience of intra-operative high intensity focused ultrasound in patients with colorectal liver metastases: a phase I-IIa study. 2006a; 13(3):228-233. Twelve-month prostate volume reduction after MRI-guided transurethral ultrasound ablation of the prostate. 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. Hematology/Oncology Subcommittee review. Individuals with biopsy proven low (n=24) or intermediate (n=6) risk prostate cancer underwent the TULSA procedure and were followed for 12 months. HIFU or MRgFUS has also been studied as a potential treatment of various cancers. 2011; 185(4):1246-1254. 2017; 120(2):246-256. AIUM Practice Parameter for the Performance of Limited Obstetric Ultrasound Examinations by Advanced Clinical Providers. TULSA has been proposed as a localized treatment of unilateral intermediate risk prostate cancers in individuals not interested in active surveillance (Klotz, 2021). Due to variances in utilization patterns, each plan may choose whether to adopt a particular Clinical UM Guideline. Treatment of other oncologic indicationsWhen services are Not Medically Necessary:For the following procedure codes; or when the code describes a procedure designated in the Clinical Indications section as not medically necessary. Palermo G, Totaro A, Sacco E, et al. 2012; 13(6):622-632. 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. J Natl Cancer Inst. Kenkhuis MJA, Bakker M, Bardi F, ET AL. The recommendations are based on limited data. American College of Radiology (ACR). 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. Cancer. 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. 2021; 127(5):544-552. 2006b; 97(1):56-61. Schatzl G, Madersbacher S, Djavan B, et al. Updated Discussion/General Information and Reference sections. 2021: S1078-1439(21)00173-3. Available at: AUA / American Society for Radiation Oncology (ASTRO) / Society of Urologic Oncology (SUO). U.S. Food and Drug Administration (FDA). The PSA level, which had dropped following treatment, remained low. Alternatively, commercial or FEP plans or lines of business which determine there is not a need to adopt the guideline to review services generally across all providers delivering services to Plans or line of businesss members may instead use the clinical guideline for provider education and/or to review the medical necessity of services for any provider who has been notified that his/her/its claims will be reviewed for medical necessity due to billing practices or claims that are not consistent with other providers, in terms of frequency or in some other manner. Uchida T, Ohkusa H, Yamashita H, et al. Step 2: After you become pregnant, you will join HIP Maternity. Before you decide to pass on Plan F, though, do your due diligence and see how much the insurance . Post-treatment biopsies were available in 77% of subjects. 2008; 53(6):1194-1201. Local recurrence of prostate cancer after external beam radiotherapy: early experience of salvage therapy using high-intensity focused ultrasonography. On October 9, the FDA granted de novo clearance to SonaCare Medical, LLC (Charlotte, NC) to market the Sonablate 450 for prostate tissue ablation. For appeals related to well-being incentive credits, In Ohio: Community Insurance Company. 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.. Matthew Thornton Health Plan, Inc./Anthem Blue Cross and Blue Shield Coverage for: Individual + Family | Plan Type: HMO Anthem Silver Pathway X Enhanced HMO 5500/20% S05 ($0 Preferred Virtual Care + $0 Select Drugs) The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. 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. The five HIFU trials included a total of only 136 individuals. Focal salvage high-intensity focused ultrasound in radiorecurrent prostate cancer. To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the member's card. Eur Urology. 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. Updated Description, Discussion, References and Websites for Additional Information sections. Available at: Dahm P, Brasure M, Ester E, et al. Results indicated that median survival in RFA, IRE and SBRT was more favorable compared to HIFU. The feasibility and safety of high-intensity focused ultrasound as salvage therapy for recurrent prostate cancer following external beam radiotherapy. CA/SG/Anthem Platinum PPO 15/250/10%/6BPB/01-22 Page 1 of 13 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: PPO Anthem Platinum PPO 15/250/10% The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Pain palliation for localized metastatic bone pain. Salvage high-intensity focused ultrasound for patients with recurrent prostate cancer after brachytherapy. 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. . 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. 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). MedlinePlus. Alternatively, the reduced tumor mass caused by thermal ablation may have an analgesic effect. The primary endpoint was achieved in 96% (110/115) of participants. July 23, 2021. Added medically necessary indication when there is a known or suspected exposure to the Zika virus to the Clinical Indications section. Last Reviewed: August 25, 2022. There are currently two ultrasound ablative techniques. The treatment group reported an AE frequency of 76.2% versus 23.8% in the sham group. MPTAC review. 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) Following treatment, no residual tumor was found in 46.2% of cases. Updated Coding section; added ICD-10-CM code ranges O98.111-O98.119, O99.310-O99.313, O99.320-O99.323, O99.330-O99.333. 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. FAQ 133, July 2021. Pain severity was measured using a 10-point pain scale questionnaire. An obstetrical ultrasound in the second or third trimester includes an evaluation of fetal number, cardiac activity, presentation, amniotic fluid volume, placental position, fetal biometry, and an anatomic survey. Accessed on October 20, 2022. Eur Radiol. June 2021. Palliative Care. Ahmed HU, Cathcart P, McCartan N, et al. 2017; 71(2):267-273. The document header wording updated from Current Effective Date to Publish Date. Updated Discussion/General Information, References and Websites for Additional Information sections. 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 Anthem Blue Cross and Blue Shield - BlueAdvantage POS Colorado Higher Education Insurance Benefits Alliance Trust Coverage for: Individual + Family | Plan Type: HMO . 2005; 51(10):651-658. Clin Genitourin Cancer. Updated Discussion/General Information, References and Websites for Additional Information sections. The clearance was based upon the Ablatherm device as the predicate device. Practice Advisory Interim Guidance for Care of Obstetric Patients During a Zika Virus Outbreak. Transrectal high-intensity focused ultrasound using the Ablatherm device in the treatment of localized prostate carcinoma. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Added Websites for Additional Information section. August 27, 2020. 2005; 4(3):187-192. J Urol. Uchida T, Tomonaga T, Kim H, 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. 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. Poissonnier L, Chapelon JY, Rouviere O, et al. For other common visits, this is what you'll pay with PPO. Quality of life following high-intensity focused ultrasound for the treatment of localized prostate cancer: a prospective study. In 2021, Nair and colleagues reported the 3-year outcomes of the participants in the Chin study. P110039. Focused ultrasound for the treatment of bone metastases: effectiveness and feasibility. Yutkin V, Ahmed HU, Donaldson I, et al. Federal and State law, as well as contract language, and Medical Policy take precedence over Clinical UM Guidelines. Rooms for rent in Bury flat and house shares - 3 currently available. 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. Cochrane Database Syst Rev. American College of Radiology (ACR). Invest Radiol. Updated Description, Discussion and References sections. Guideline for the management of clinically localized prostate cancer: 2007 update. 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). 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. American Urological Association (AUA). Ultrasound averages range from $54 to $100. This early study focused on safety and technical feasibility rather than clinical outcomes. 2008; 38(3):192-199. 2005; 2(4):191-198. CA/IND/Anthem Silver 94 HMO/657X/01-22 Page 1 of 11 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 94 HMO The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The guideline addresses several non-extirpative therapies and concluded that these therapies, including HIFU, are investigational for the treatment of renal masses. PSA nadir as a predictive factor for biochemical disease-free survival and overall survival following whole-gland salvage HIFU following radiotherapy failure. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. 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. Transurethral ultrasound ablation (TULSA), which delivers directional thermal ultrasound via a catheter inserted into the urethra, is specific to prostate cancer. Zacharakis E, Ahmed HU, Ishaq A, et al. Updated References and Websites for additional information sections. 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. . In brief: classifications in brief: Mirels' classification: metastatic disease in long bones and impending pathologic fracture. Obstetric Care Consensus. Approved May 19, 2020. Available at: Second and Third Trimester Vaginal Bleeding. ; AUA Prostate Cancer Clinical Guideline Update Panel. MPTAC review. 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. Reaffirmed 2021. Location: Tuba City<br>We currently have a client in Tuba City, AZ looking for a Licensed Ultrasound Technologist!<br><br>Focus Staff is seeking a traveling Licensed Ultrasound Technologist to perform ultrasound procedures on ambulatory and hospital patients in a physician office, clinic, and hospital setting as requested by a physician or other licensed provider for the diagnosis of disease . Five years experience of transrectal high-intensity focused ultrasound using the Sonablate device in the treatment of localized prostate cancer. Kanthabalan A, Peters M, Van Vulpen M, et al. According to the FDA labeling, a nonunion is considered to be established when the fracture site shows no visibly progressive signs of healing. The use of high intensity focused ultrasound (HIFU) is considered medically necessary for pain palliation in individuals with localized metastatic bone pain when all the following criteria are met: High intensity focused ultrasound (HIFU) is considered not medically necessary when the above criteria are not met and for all other indications, including but not limited to, the treatment of prostate cancer. J Ultrasound Med. TULSA is considered not medically necessary for any indication, including but not limited to prostate cancer. The current evidence is insufficient to support the use of HIFU as a generally accepted oncological treatment. The use of HIFU in the setting of breast cancer treatment may not allow for an adequate collection of tumor specimens to evaluate the tumor histopathology. 2020; 22:79-87. Previously, this recommendation was graded as a 2A. Systematic review of high-intensity focused ultrasound ablation in the treatment of breast cancer. 2018; 51(4):463-469. Ultrasound is currently being used as a therapeutic treatment, for example, lithotripsy to disintegrate kidney stones. As of January 10, 2022, through January 31, 2022, Anthem and its delegated entities will suspend select prior authorization requirements to allow healthcare providers to focus on caring for patients diagnosed with COVID-19. We are now accepting all Anthem Blue Cross Blue Shield patients. Providers are responsible for billing the appropriate CPT code, modifier, and diagnosis combinations. 2007; 177(6):2106-2131. Focal therapy for localized prostate cancer: a phase I/II trial. Comparing high-intensity focal ultrasound hemiablation to robotic radical prostatectomy in the management of unilateral prostate cancer: a matched-pair analysis. 2010; 468(10):2825-2827. CO CHEIBA Custom Blue Priority PPO/BluePreferred Plan F 01 -20 1 of 15 Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2021- 12/31/2021 Anthem Blue Cross and Blue Shield: Prime Blue Priority PPO Updated Coding, Description, Discussion/General Information, and References. Mirels scoring system: A scoring system based upon lesion characteristics and pain levels used to classify pathologic fracture risk. Rockville (MD): Agency for Healthcare Research and Quality (US); 2020 Sep. Report No. Anthem - Blue Cross Blue Shield Long awaited and much anticipated? Liberman B, Gianfelice D, Inbar Y, et al. 2004; 58(4):382-390. 1999b; 39(1):41-46. 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). The authors reviewed 9 studies with a total of 167 participants. Clarification to Not Medically Necessary Statement. 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. BJU Int. 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. . This document addresses the use of maternity ultrasound in the outpatient setting.