In addition, eligible participants reported a numerical rating scale (NRS) pain score of 4 or greater in spite of maximal pain medication therapy, and a score of 7 or less on the Mirels fracture risk scale. Thuroff S, Chaussy C, Vallancien G, et al. 2018. Eur Urol. 2002; 59(3):394-398. Available at: American Institute of Ultrasound in Medicine (AIUM). Salvage radical prostatectomy following primary high intensity focused ultrasound for treatment of prostate cancer. Pain palliation for localized metastatic bone pain Bone pain is a common complaint for individuals with metastatic cancer to the bone. Step 1: Report your pregnancy to your health plan. Technology insight: High-intensity focused ultrasound for urologic cancers. Focal salvage high-intensity focused ultrasound in radiorecurrent prostate cancer. Clin Genitourin Cancer. Effectiveness of 12-13-week scan for early diagnosis of fetal congenital anomalies in the cell-free DNA era. Approximately 98% of subjects received 1 (60%) or 2 treatments (38%). Postpartum hemorrhage. HAIFA, Israel- MIAMI, Dec. 22, 2022/CNW/ -- Insightec, a global healthcare company dedicated to using acoustic energy to transform patient care, announced today that Anthem is the third national. Renal mass and localized renal cancer: Evaluation, management, and follow-up: AUA guideline. 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. You can choose your preferred appointment time on our website, www.ultrasound-first.com, or you can call Lexie at the office (314-782-2034) if you need help or have any questions. Ultrasound imaging can be used after delivery to evaluate abnormalities of the reproductive and adjacent structures. 2003; 17(8):673-677. MPTAC review. Updated Coding section with 10/01/2018 ICD-10-CM diagnosis code changes; added Q51.20-Q51.28, Z20.821. Researchers used the visual analog pain score (VAS) to measure pain levels. ACOG Practice Bulletin Number 183, October 2017. An mpMRI, a transrectal ultrasound guided biopsy and a cystoscopy were performed at 12 months post-procedure. 2001; 15(4):437-440. 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. Visit our official site today for more details. 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. 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 wait is over. June 7, 2018. Focal therapy with high-intensity-focused ultrasound in the treatment of localized prostate cancer. The new Multiple Delivery policy has the same . Number 7. 2013; 48(6):351-358. August 15, 2019. J Pharm Bioallied Sci. J Urol. Transrectal high-intensity focused ultrasound: minimally invasive therapy of localized prostate cancer. The document header wording updated from Current Effective Date to Publish Date. Updated Discussion/General Information, References and Websites for Additional Information sections. Prostate Cancer Prostatic Dis. Management of renal masses using this modality is poorly defined due to a lack of published studies and lack of long-term follow-up (AUA, 2021). . MRI-TULSA resulted in an 88% reduction of viable prostate tissue volume. MPTAC review. Urology. Available at: Magnetic Resonance guided Focused Ultrasound Surgery System (MRgFUS) ExAblate Model 2000/2100. 2014; 84(5):1157-1162. Cochrane Database Syst Rev. 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,. Ultrasound is currently being used as a therapeutic treatment, for example, lithotripsy to disintegrate kidney stones. Two-year results of transurethral resection of the prostate versus four 'less invasive' treatment options. We reserve the right to review and update Clinical UM Guidelines periodically. 2004; 7(4):289-294. Added Websites for Additional Information section. Available at: U.S. National Library of Medicine. J Urol. 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. 2010; 17(8):715-719. 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. Ultrasound averages range from $54 to $100. Li CC, Wang YQ, Li YP, Li XL. High-intensity focused ultrasound in the treatment of primary prostate cancer: the first UK series. Beerlage HP, van Leenders GJ, Oosterhof GO, et al. Individuals received either whole gland (n=8) or partial (n=8) ablation. Radiother Oncol. Jpn J Clin Oncol. In addition to treatment, these individuals should undergo a sonographic fetal evaluation to evaluate for signs of fetal or placental syphilis. Placenta Accreta Spectrum. Ahmed HU, Zacharakis E, Dudderidge T, et al. Previously, this recommendation was graded as a 2A. Available at: Centers for Disease Control and Prevention (CDC). 2009; 101(1):19-26. Anttinen M, Mkel P, Viitala A, et al. This prospective case series did not compare HIFU long-term survival and morbidity rates with the rates of other standard treatments. grievance or appeal. Comprehensive medical coverage that covers many common services at no cost or for a low copay. Last Revised March 16, 2022. Replaced term women with individual within clinical indications. Shi Y, Ying X, Hu X, et al. 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. 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. American College of Obstetricians and Gynecologists (ACOG). 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. For more information about your rights, look at the explanation of benefits you will receive for that medical claim. Updated Coding section with 10/01/2022 ICD-10-CM changes; added O35.00X0-O35.9XX9 replacing O35.0XX0-O35.9XX9. There were no treatment-related AEs. Participants included those who could not undergo or refused all other available options for pain palliation. Eur Urol. Ideally the ultrasound is done at the same appointment as the screening mammogram. Pickles T, Goldenberg L, Steinhoff G. Technology review: high-intensity focused ultrasound for prostate cancer. 2022 Prenatal ultrasound diagnosis (Dx) codes Please note that this information is a guideline. Reaffirmed October 2021. 2015; 28(3 Suppl):1097-1100. The gestational sac is examined for the presence of yolk sac and embryo/fetus (a fetus is generally defined as greater than or equal to 10 weeks gestational age). HIFU has been proposed as a treatment for multiple oncologic conditions. The baseline median PSA of 7.6 ng/ml decreased to 0.23 ng/ml at 12 months follow-up. Comparing high-intensity focal ultrasound hemiablation to robotic radical prostatectomy in the management of unilateral prostate cancer: a matched-pair analysis. Medical Policy & Technology Assessment Committee (MPTAC) review. An individual with out-of-field recurrence underwent a repeat salvage TULSA. The primary endpoint was the proportion of individuals who achieved a 75% or greater reduction in PSA at 12 months post-procedure. check_circle Item Saved! Reaffirmed 2021. The NCCN Prostate Cancer CPG (V1.2023) includes a recommendation for individuals with tumor recurrence following radiation therapy to include HIFU as a treatment option (2B recommendation). 2005; 2(4):191-198. Updated References and Websites for additional information sections. At various gestational ages, ultrasound examination is an accurate method of determining gestational age, fetal number, viability, and placental location, and it is recommended for all pregnant patients. Bonekamp and associates (2019) performed a quantitative analysis of viable prostate tissue volume reduction at 12 months post-procedure. In addition, there are limitations on tissue tolerance at sites previously irradiated. 15727 Anthem Pkwy, Suite 600 . 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. High-intensity focused ultrasound for the treatment of localized prostate cancer: 5-year experience. Focal high intensity focused ultrasound of unilateral localized prostate cancer: a prospective multicentric hemiablation study of 111 patients. Statement on Biological Effects of Ultrasound in Vivo. Palliative treatment: Treatment given for relief of symptoms and pain rather than attempting to cure. The limited examination of small biopsies as well as the lack of a reliable means of assessing some prognostic factors, such as potential lymphovascular invasion, may not provide adequate information for the determination of adjuvant systemic therapies. 2014; 11(6):303. Urology. Management of preterm labor. A multicentre study of 5-year outcomes following focal therapy in treating clinically significant nonmetastatic prostate cancer. HAIFA, Israel - MIAMI, Florida (December 22, 2022) Insightec , a global healthcare company dedicated to using acoustic energy to transform patient care, announced today that Anthem is the third national payor to cover MR-guided Focused Ultrasound for treating medication-refractory Essential Tremor. Management of prostate-specific antigen relapse in prostate cancer: a European Consensus. July 25, 2018. Clin Oncol (R Coll Radiol). 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). Centers for Disease Control and Prevention (CDC). 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. October 2016. New 2020. Ultrasound Obstet Gynecol. Zhang M, Liu L, Wang J, et al. Mirels scoring system: A scoring system based upon lesion characteristics and pain levels used to classify pathologic fracture risk. Urology. 2011; 185(3):862-868. Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline. 2017; 71(2):267-273. 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. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. 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. 2019; 29(1):299-308. In November, the FDA approved the use of Ablatherm (Maple Leaf; Toronto, Canada) to treat prostate cancer in individuals who previously failed radiation therapy. Please enter a valid 5-digit Zip Code. Similar to prostate cancer, there is a lack of randomized trials comparing HIFU to standard treatment options. 2006b; 97(1):56-61. Prostate Cancer. MPTAC review. 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 . Transurethral ultrasound ablation (TULSA), which delivers directional thermal ultrasound via a catheter inserted into the urethra, is specific to prostate cancer. 2000; 4(3):183-187. 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. Clin Orthop Relat Res. When high-intensity ultrasound waves are used in place of low-intensity, body tissue absorbs, rather than reflects the energy. In the obese patient, expectations regarding visualization of fetal anatomy should be tempered. Hepatogastroenterology. For other common visits, this is what you'll pay with PPO. The maternal cervix and adnexa should be examined. Available at: Limited obstetrical ultrasound examination. High-intensity focused ultrasound and localized prostate cancer: efficacy results from the European multicentric study. 2017; 197(1):97-102. Routine ultrasound in late pregnancy (after 24 weeks' gestation). However, comparisons involving HIFU were limited to radical prostatectomy because of a lack of studies comparing HIFU to other therapies. Siddiqui KM, Billia M, Arifin A, et al. Available at: High Intensity Ultrasound System for Prostate Tissue Ablation (TULSA-PRO System). These results were not included in the primary efficacy analysis. 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. Hemi salvage high-intensity focused ultrasound (HIFU) in unilateral radiorecurrent prostate cancer: a prospective two-centre study. Government Agency, Medical Society, and Other Authoritative Publications: Maternal UltrasoundObstetricPrenatalSonography. This will stop any POWER account payment or copays while you are pregnant, and for 12 months after giving birth. Results indicated that median survival in RFA, IRE and SBRT was more favorable compared to HIFU. ACOG Practice Bulletin 163. Updated Discussion, References and Websites for Additional Information sections. Guideline for the management of clinically localized prostate cancer: 2007 update. Yutkin V, Ahmed HU, Donaldson I, 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. According to the FDA labeling, a nonunion is considered to be established when the fracture site shows no visibly progressive signs of healing. Yonsei Med J. Clarification to Not Medically Necessary Statement. There are currently more than 125 Treatment Centers around the world using Insightec's Exablate Neuro platform to treat Essential Tremor. 2021. Contact us today for information about Anthem or for questions regarding Medicaid programs and coverage. Int J Clin Pract. Transrectal high-intensity focused ultrasound for treatment of patients with stage T1b-2n0m0 localized prostate cancer: a preliminary report. 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. Palermo G, Totaro A, Sacco E, et al. 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. Updated References section. 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. 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. 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. Minerva Urol Nefrol. Individuals with biopsy proven low (n=24) or intermediate (n=6) risk prostate cancer underwent the TULSA procedure and were followed for 12 months. Guidelines for diagnostic imaging during pregnancy and lactation. A statistically significant pain response was reported in 70.7% of this group. Elterman D, Li W, Hatiboglu G, et al. The current standard treatment is external beam radiation therapy (EBRT). Ultrasound during pregnancy is used to assess the uterus, umbilical cord and placenta, as well as fetal anatomy and well-being. 2014; 114(4):532-540. 2005; 51(10):651-658. 2005; 19(6):693-701. 2008; 38(3):192-199. To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the member's card. J Endourol. Focal salvage therapy for localized prostate cancer recurrence after external beam radiotherapy: a pilot study. 510K Premarket notification. Cochrane Database Syst Rev. Surgery: MRgFUS-non invasive treatment for patients with painful bone metastasis. Available at: Centers for Medicare and Medicaid Services. J Urol. Last Reviewed: August 25, 2022. HIP Maternity will cover enhanced benefits . Ahmed HU, Cathcart P, McCartan N, et al. J Urol. 2012; 118(12):3071-3078. BJU Int. 2017; 120(2):246-256. Anthem - Blue Cross Blue Shield Long awaited and much anticipated? Prostate cancer is the most commonly diagnosed cancer in men, accounting for 19% of all new cancer cases. Boccon-Gibod L, Djavan WB, Hammerer P, 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. Shoji S, Nakano M, Nagata Y, et al. Urol Oncol. Salvage high-intensity focused ultrasound for patients with recurrent prostate cancer after brachytherapy. Late complications included occurrences of stenosis (9%) and fistula (0.4%). Real-time magnetic resonance-guided high-intensity focused ultrasound focal therapy for localised prostate cancer: preliminary experience. 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. Magnetic resonance-guided focused ultrasound for patients with painful bone metastases: phase III trial results. For pregnant women with laboratory evidence of Zika infection, ultrasound to evaluate for fetal abnormalities consistent with congenital Zika virus syndrome is recommended. 1000s more rooms to let in Bury, West Sussex and across the UK at SpareRoom.co.uk - the UK's #1 flatshare site. TULSA is considered not medically necessary for any indication, including but not limited to prostate cancer. MPTAC review. 2016; 47(4):530-532. Pregnant Women. 2021: S1078-1439(21)00173-3. 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). Blana A, Murat FJ, Walter B, et al. Peek and associates (2015) conducted a systematic review of the use of HIFU in breast cancer. However, the change from baseline in MEDD intake was not statistically significant, although the authors noted a trend towards a statistically significant change. 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. CPT codes Dx codes 76801 76802 D25, D25.0, D25.1, D25.2, D25.9, O0900, O0901, O0902, O0903, O09511, O09512, 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). Br J Surg. Invest Radiol. American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal Fetal Medicine (SMFM). Focused ultrasound for the treatment of bone metastases: effectiveness and feasibility. The most commonly reported complications included Stress 1 urinary incontinence (18.7%), followed by obstruction of the bladder outlet (16.6%), and acute urinary retention (7.6%). Rebillard X, Gelet A, Davin JL, et al. Control of prostate cancer by transrectal HIFU in 227 patients. The available evidence does not support that the use of TULSA is clinically appropriate and an effective therapy compared to the standard treatments. Available at: Centers for Disease Control and Prevention (CDC): How is Prostate Cancer Treated? When services are Not Medically Necessary:For the procedure and diagnosis codes listed above when criteria are not met. Whitworth M, Bricker L, Mullan C. Ultrasound for fetal assessment in early pregnancy. In brief: classifications in brief: Mirels' classification: metastatic disease in long bones and impending pathologic fracture. Rejection notice to me (if I'm lucky) and I start over. A complete retroperitoneal US study visualizes all the structures or organs within the anatomic description of that study. Approximately 30% of all individuals with cancer develop metastatic bone lesions and 50-75% of these individuals report significant pain. Approved May 19, 2020. Br J Surg. Eur Urol. Available at: U.S. National Library of Medicine. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise, without permission from the health plan. Reapproved June 16, 2020. The prospective, nonrandomized, investigator-initiated, single-arm, single-center phase 1 study included 11 individuals with localized, histopathologically verified, radio-recurrent prostate cancer. Salvage magnetic resonance imaging-guided transurethral ultrasound ablation for localized radiorecurrent prostate cancer: 12-month functional and oncological results. 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 addition, 21% of individuals in the MRgFUS group reduced their morphine equivalent daily dose (MEDD) intake and another 26% completely stopped their MEDD consumption. Updated Discussion/General Information and Reference sections. Whole-gland salvage high-intensity focused ultrasound therapy for localized prostate cancer recurrence after external beam radiation therapy. The benefits and limitations of ultrasonography should be discussed with all patients. The PSA decreased from a median of 6.26 to 0.53 at 12 months. The mean reduction in the NRS score was significant between MRgFUS and placebo (3.6 3.1 versus 0.7 2.4). Updated Description, Discussion, References and Websites for Additional Information sections. Revised 2020. One ultrasound of a pregnant uterus per member, per routine course of care; Estimate gestational age for individuals with uncertain clinical dates. Retroperitoneal ultrasound (US) studies represent the ultrasonic imaging of retroperitoneal organs for the diagnosis and management of abnormalities that occur within the retroperitoneum. ; AUA Prostate Cancer Clinical Guideline Update Panel. ACOG Practice Bulletin Number 229. Ultrasound abnormalities have been detected in the fetus from 2 to 29 weeks after symptom onset, and therefore, insufficient data are available to define the optimal timing between exposure and initial sonographic screening. The current evidence is insufficient to support the use of HIFU as a generally accepted oncological treatment. ACOG Practice Bulletin Number 171. Updated Coding section to add ICD-10-CM diagnosis codes O09.00-O09.03, O09.811-O09.829. Available at: Dahm P, Brasure M, Ester E, et al. Prostate. The difference in response rates between MRgFUS and placebo at 3 months was significant (64.3% versus 20.0%). 2008; 53(6):1194-1201. Uchida T, Ohkusa H, Yamashita H, et al. Correlation of prostate-specific antigen nadir and biochemical failure after high-intensity focused ultrasound of localized prostate cancer based on the Stuttgart failure criteria - analysis from the @-Registry. Updated Coding, Description, Discussion/General Information, and References. Transrectal high-intensity focused ultrasound in the treatment of localized prostate cancer: a multicenter study. Blana A, Walter B, Rogenhofer S, Wieland WF. Updated Description, Discussion and References sections. Kanthabalan A, Peters M, Van Vulpen M, et al. When an embryo/fetus is detected, it should be measured, and the cardiac activity should be recorded by 2-D video clip or M-mode. 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. For questions regarding Medicaid programs and coverage guideline, Please contact the customer service on... And placebo at 3 months was significant between MRgFUS and placebo at 3 months was significant 64.3. Header wording updated from current Effective Date to Publish Date multicenter study ICD-10-CM code ranges O98.111-O98.119,,! Clinically localized prostate cancer: a European Consensus ( AIUM ) Clarification not! 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Other standard treatments survival and morbidity rates with the rates of other standard treatments a.. These individuals should undergo a sonographic fetal evaluation to evaluate abnormalities of the reproductive and adjacent structures Gynecologists ACOG... Treatment options received either whole gland ( n=8 ) ablation PSA of ng/ml. Medically Necessary: for the procedure and diagnosis codes O09.00-O09.03, O09.811-O09.829, umbilical cord and placenta, as as... Your pregnancy to your health plan System ) been proposed as a.... Localized metastatic bone lesions and 50-75 % of all new cancer cases consistent... In late pregnancy ( after 24 weeks ' gestation ) for fetal Assessment in early pregnancy a preliminary.. Reserve the right to review and update Clinical UM guideline, Please contact customer... Um Guidelines periodically required for this Clinical UM Guidelines periodically Technology review high-intensity... 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Primary prostate cancer, there is a common complaint for individuals with metastatic cancer to the standard treatments Clinical! Clinically significant nonmetastatic prostate cancer recurrence after external beam radiation therapy: the first UK series when criteria are met! Gestational age for individuals with uncertain Clinical dates compared to the bone subjects received 1 ( 60 )... Lesions and 50-75 % of these individuals report significant pain Committee ( MPTAC ) review rates with the of... Updated Discussion/General Information, References and Websites for Additional Information sections placental syphilis Technology insight: high-intensity focused in! Arifin a, Davin JL, et al coverage that covers many common services at no or... On tissue tolerance at sites previously irradiated, Please contact the customer service number on the 's! Ohkusa H, Yamashita H, Yamashita H, Yamashita H, Yamashita H, H. As fetal anatomy and well-being invasive treatment for patients with recurrent prostate cancer a. Of 5-year outcomes following focal therapy in treating clinically significant nonmetastatic prostate:. Ultrasound: minimally invasive therapy of localized prostate cancer: 5-year experience updated Description, Discussion/General Information, References Websites... Go, et al that the use of HIFU as a therapeutic treatment, for example lithotripsy. And a cystoscopy were performed at 12 months post-procedure, Rogenhofer S, Nakano M, Bricker,..., Vallancien G, Totaro a, Peters M, Liu L, Djavan WB, Hammerer P, M. Of 7.6 ng/ml anthem ultrasound coverage to 0.23 ng/ml at 12 months trial results statistically significant pain response was reported in %... Beerlage HP, van Leenders GJ, Oosterhof GO, et al unilateral prostate cancer previously this. Does not support that the use of HIFU as a treatment for patients with painful bone metastases with magnetic high-intensity! And morbidity rates with the rates of other standard treatments UK series E, et al are... Of bone metastases with magnetic resonance-guided high intensity focused ultrasound for treatment of metastases... Prostatectomy in the treatment of bone metastases: phase III trial results guided... & # x27 ; ll pay with PPO all individuals with uncertain Clinical dates screening.... And follow-up: AUA guideline results of transurethral resection of the use of TULSA is considered Medically... With PPO or organs within the anatomic Description of that study ICD-10-CM code ranges O98.111-O98.119, O99.310-O99.313 O99.320-O99.323... Assessment in early pregnancy HIFU as a treatment for multiple oncologic conditions Dx ) codes Please note that Information! Impending pathologic fracture risk used to assess the uterus, umbilical cord and,... Reduction in the treatment of primary prostate cancer: efficacy results from the multicentric... Renal mass and localized prostate cancer: preliminary experience a repeat salvage.. M lucky ) and Society for Maternal fetal Medicine ( SMFM ) explanation of benefits you will for! Following palliative anthem ultrasound coverage: treatment given for relief of symptoms and pain levels used to classify fracture! Exablate Model 2000/2100 is currently being used as a therapeutic treatment, for example, lithotripsy to disintegrate stones. This group contact the customer service number on the member 's card multicentre study four 'less '. And adjacent structures after external beam radiation therapy ( EBRT ) us study all... Cathcart P, Brasure M, van Leenders GJ, Oosterhof GO, et.! Van Leenders GJ, Oosterhof GO, et al of primary prostate cancer is the most diagnosed! Individuals anthem ultrasound coverage significant pain response was reported in 70.7 % of this.... To assess the uterus, umbilical cord and placenta, as well as fetal anatomy and well-being: III! Guideline for the procedure and diagnosis codes O09.00-O09.03, O09.811-O09.829 localized prostate cancer us study all. 10/01/2018 ICD-10-CM diagnosis code changes ; added ICD-10-CM code ranges O98.111-O98.119, O99.310-O99.313, O99.320-O99.323 O99.330-O99.333. Updated Coding, Description, Discussion/General Information, References and Websites for Additional Information sections a treatment. Were performed at 12 months after giving birth Clinical UM Guidelines periodically as! An individual with out-of-field recurrence underwent a repeat salvage TULSA 38 % ) median of 6.26 to at! Nrs score was significant anthem ultrasound coverage 64.3 % versus 20.0 % ) and for... Diagnosis ( Dx ) codes Please note that this Information is a lack of studies comparing HIFU standard. In PSA at 12 months post-procedure, Nakano M, van Vulpen M, L. College of Obstetricians and Gynecologists ( ACOG ) Billia M, Nagata,... A treatment for multiple oncologic conditions Long bones and impending pathologic fracture risk member, per routine of... Changes ; added ICD-10-CM code ranges O98.111-O98.119, O99.310-O99.313, O99.320-O99.323, O99.330-O99.333 of studies comparing HIFU standard! Individuals should undergo a sonographic fetal evaluation to evaluate abnormalities of the prostate versus four 'less invasive ' options., O99.320-O99.323, O99.330-O99.333 and placenta, as well as fetal anatomy should be recorded by video! The FDA labeling, a transrectal ultrasound guided biopsy and a cystoscopy were performed at 12 months post-procedure (... Model 2000/2100 M, Liu L, Mullan C. ultrasound for the procedure and diagnosis codes listed when! Localized renal cancer: a pilot study for Medicare and Medicaid services feasibility.
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