TULSA is delivered by a system which includes real-time MR thermometry as well as robotically-driven directional thermal ultrasound in a closed loop system to ablate whole gland or targeted areas of the prostate. It is completely automated and therefore extremely rigid. Ultrasound Tech in San Antonio, Texas, United States. 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. 2004; 7(4):289-294. J Urol. Eur Urol. 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. Accessed on October 20, 2022. 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). The authors reported that salvage TULSA was technically feasible and showed encouraging early results but have not been compared to standard therapy. 2015; 102(8):873-882. Kanthabalan A, Peters M, Van Vulpen M, et al. 2012; 105(2):198-202. Beerlage HP, Thuroff S, Debruyne FM, et al. Ahmed HU, Cathcart P, McCartan N, et al. Available at: American Cancer Society. Prostate Cancer Prostatic Dis. The focus of this study was the use of prostate specific antigen (PSA) as a predictor of disease-free survival after HIFU, not the outcomes related to HIFU treatment. Clin Orthop Relat Res. Updated Coding section; corrected ICD-10 diagnosis code O41.00X0. Cancer. 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 2013, Napoli and colleagues treated 18 individuals with painful bone metastases with MRgFUS. 2017; 197(1):97-102. Review January 10, 2022. Palliative Care. 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. Crouzet S, Murat FJ, Pommier P, et al. 2012; 116(3):201-205. BJU Int. AIUM Practice Parameter for the Performance of Detailed Diagnostic Obstetric Ultrasound Examinations Between 12Weeks 0Days and 13Weeks 6Days. 2015; 194(1):114. First clinical experience of intra-operative high intensity focused ultrasound in patients with colorectal liver metastases: a phase I-IIa study. Medicare Supplement Plan F is great because it provides the most coverage of the 10 currently available MedSup plans. PLoS One. 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 . 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. The authors theorized that the high rate of salvage treatment at 3 years follow-up could be attributed to suboptimal staging and treatment. 2014; 84(5):1157-1162. 2009; 16(1):140-146. Int J Urol. High-intensity focused ultrasound and localized prostate cancer: efficacy results from the European multicentric study. 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. Zip Code or City, State . 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. 2011; 185(4):1246-1254. Individuals with biopsy proven low (n=24) or intermediate (n=6) risk prostate cancer underwent the TULSA procedure and were followed for 12 months. High Intensity Ultrasound System For Prostate Tissue Ablation (Ablatherm). 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. 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.. Ideally the ultrasound is done at the same appointment as the screening mammogram. 2005; 2(4):191-198. NOTE: Information about the cost of this plan (called the . Yutkin V, Ahmed HU, Donaldson I, et al. The mean follow-up period was 6.4 years (range, 0.2-13.9). Providers are responsible for billing the appropriate CPT code, modifier, and diagnosis combinations. Cancer. NCCN Clinical Practice Guidelines in Oncology. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. MPTAC review. ; AUA Prostate Cancer Clinical Guideline Update Panel. Eur Urol. 1000s more rooms to let in Bury, West Sussex and across the UK at SpareRoom.co.uk - the UK's #1 flatshare site. Routine ultrasound in late pregnancy (after 24 weeks' gestation). Liberman and associates (2009) used MRgFUS to treat 31 individuals with painful bone metastases who had exhausted or refused all other pain palliation methods. J Pharm Bioallied Sci. Available at. Focal therapy for localised unifocal and multifocal prostate cancer: a prospective development study. 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. 2000; 4(3):183-187. Approximately 98% of subjects received 1 (60%) or 2 treatments (38%). ACOG Practice Bulletin 163. Available at: Centers for Disease Control and Prevention (CDC). 2015; 10(2):e0118212. Removed ICD-9 codes from Coding section. Safety trial of high-intensity focused ultrasound therapy for pancreatic cancer. Adverse events included grade 1 or 2 hematuria, urinary tract infections or acute urinary retention, and grade 3 epididymitis. The SBC shows you how you and the plan would share the cost for covered health care services. There are currently more than 125 Treatment Centers around the world using Insightec's Exablate Neuro platform to treat Essential Tremor. The authors concluded, Although newer modalities hold promise, we need higher quality studies to assess patient important outcomes to guide evidence-based clinical practice.. ACR-ACOG-AIUM-SMFM-SRU Practice parameter for the performance of obstetrical ultrasound. The clearance was based upon the Ablatherm device as the predicate device. Updated References and Websites for additional information sections. While there is no reliable evidence to support ultrasounds performed during pregnancy will harm a fetus, there is general agreement that the casual use of ultrasonography during pregnancy should be avoided (ACOG, 2018). HIFU is a non-invasive ablative procedure which has the advantage of sparing surrounding tissue which may reduce postoperative morbidity and hasten recovery. Therapies for clinically localized prostate cancer [Internet]. 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. Shi Y, Ying X, Hu X, et al. Br J Cancer. . check_circle Item Saved! The feasibility and safety of high-intensity focused ultrasound as salvage therapy for recurrent prostate cancer following external beam radiotherapy. 2018; 74(4):422-429. Ahmed HU, Hindley RG, Dickinson L, et al. For instance, if you want to take advantage of inversion therapy, massage, ultrasound therapy, or computer-assisted adjustments, youll need to ask your insurance company about the availability of coverage for these things . 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. 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. Researchers used the visual analog pain score (VAS) to measure pain levels. 2014; 11(6):303. These results were not included in the primary efficacy analysis. Whole-gland salvage high-intensity focused ultrasound therapy for localized prostate cancer recurrence after external beam radiation therapy. 15727 Anthem Pkwy, Suite 600 . Crouzet S, Chapelon JY, Rouvire O, et al. Bone Metastases. These adjustments apply to members of Commercial business, including self-insured plans, Medicare, and Medi-Cal business. 2011; 3(3):329-338. 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 majority of attributable AEs were grade 1 or 2. 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, respectively. Pain severity was measured using a 10-point pain scale questionnaire. 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). Prostate. These options carry their own risks and side effects. Locally recurrent prostate cancer after initial radiation therapy: early salvage high-intensity focused ultrasound improves oncologic outcomes. J Endourol. Jpn J Clin Oncol. Moved content of MED.00119 High Intensity Focused Ultrasound (HIFU) for Oncologic Indications to new clinical utilization management guideline document with the same title. In brief: classifications in brief: Mirels' classification: metastatic disease in long bones and impending pathologic fracture. Hoosier Healthwise. TULSA has been proposed as a localized treatment of unilateral intermediate risk prostate cancers in individuals not interested in active surveillance (Klotz, 2021). June 7, 2018. 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. ACR Appropriateness Criteria. Single high intensity focused ultrasound session as a whole gland primary treatment for clinically localized prostate cancer: 10-year outcomes. The primary endpoint was achieved in 96% (110/115) of participants. High-intensity focused ultrasound for treatment of pancreatic cancer: a systematic review. 2015; 28(3 Suppl):1097-1100. The study has several methodological flaws, including lack of a comparison group, and uncertainty regarding the percentage of subjects who completed the follow-up period. AIUM practice guideline for the performance of obstetric ultrasound examinations. Although I've had a particular monthly claim for YEARS, it doesn't always recognize the bill. 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. Alldred SK, Takwoingi Y, Guo B, et al. Reaffirmed October 2021. Breast MRI costs an average $615 under Medicare . Lawrentschuk N, Finelli A, Van der Kwast TH, et al. Uchida T, Tomonaga T, Kim H, et al. 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). Prostate cancer is the second leading cause of death with approximately 39,430 deaths in 2018 (Bekelman, 2018). The routine use of pulsed Doppler ultrasound to either document or listen to embryonic/fetal cardiac activity is discouraged. Clin Orthop Relat Res. 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. 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