Eur Urol. Urol Oncol. 2014; 114(4):532-540. In an intent-to-treat analysis, 63% (72/115) were reported to have a complete histological response and had no evidence of cancer. Focal salvage therapy for localized prostate cancer recurrence after external beam radiotherapy: a pilot study. Under the benefits of certain plans, the following diagnostic imaging services that are received in an outpatient setting, such as in a medical office, the outpatient department of a hospital or at a freestanding imaging center may require prior approval (for dates of service on or after February 15, 2007 for Blue Cross NC commercial plans and September 1, 2010 for Blue Medicare HMO and Blue . Ultrasound Obstet Gynecol. In the absence of specific indications, the optimal time for a single ultrasound examination is at 1822 weeks of gestation. Boccon-Gibod L, Djavan WB, Hammerer P, et al. Review January 10, 2022. You bet! Ultrasound is currently being used as a therapeutic treatment, for example, lithotripsy to disintegrate kidney stones. 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. 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. Before you decide to pass on Plan F, though, do your due diligence and see how much the insurance . Available at: American Cancer Society. Pain palliation for localized metastatic bone pain Bone pain is a common complaint for individuals with metastatic cancer to the bone. We reserve the right to review and update Clinical UM Guidelines periodically. J Bone Joint Surg Am. Committee Opinion 723. Day 1 health insurance coverage and comprehensive benefits options 401(k) matching program While the analysis showed superior survival rates at 6 and 12 months in the groups which included HIFU in combination therapy, the authors noted that the overall quality of the studies was poor. July 23, 2021. Urology. A complete resolution of pain at 1 year follow-up was shown in 2 participants (Joo, 2015). Anttinen M, Mkel P, Viitala A, et al. J Ultrasound Med 2013; 32(6):1083-1101. Salvage high-intensity focused ultrasound for patients with recurrent prostate cancer after brachytherapy. 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. 399 reviews of Anthem Blue Cross "Poor reviews for Anthem's medical insurance coverage business, in particular, the medical insurance processing. Pregnant Women. 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. 15727 Anthem Pkwy, Suite 600 . No ionizing radiation (x-ray) is used in ultrasound imaging. 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. Pain palliation for localized metastatic bone pain. Effects of high-intensity focused ultrasound for treatment of abdominal lymph node metastasis from gastric cancer. Dupr A, Melodelima D, Prol D, et al. Eur Urology. Search doctors, conditions, or procedures . Please enter a valid 5-digit Zip Code. 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). The primary endpoint was achieved in 96% (110/115) of participants. 1999a; 54(2):273-277. 2008; 53(6):1194-1201. Ultrasound Tech in San Antonio, Texas, United States. J Urol. 2017; 3:CD012600. Find a doctor near you. There were no new reported serious AEs. Eur Radiol. Summary of Safety and Effectiveness Data (SSED). An mpMRI, a transrectal ultrasound guided biopsy and a cystoscopy were performed at 12 months post-procedure. CA/LG/Anthem PPO HSA/H 2000/3000/4000 20/40/73A3/01-23 Page 1 of 11 Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Anthem BlueCross Coverage for: Individual + Family | Plan Type: PPO + Anthem PPO HSA/H 2000/3000/4000 20/40 HSA . The five HIFU trials included a total of only 136 individuals. In brief: classifications in brief: Mirels' classification: metastatic disease in long bones and impending pathologic fracture. The guideline addresses several non-extirpative therapies and concluded that these therapies, including HIFU, are investigational for the treatment of renal masses. Chen L, Wang K, Chen Z, et al. Whole-gland salvage high-intensity focused ultrasound therapy for localized prostate cancer recurrence after external beam radiation therapy. 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. The majority of attributable AEs were grade 1 or 2. Int J Urol. High intensity focused ultrasound (HIFU) or magnetic resonance guided focused ultrasound (MRgFUS) involves the use of a focused high-intensity convergent ultrasound beam to destroy targeted tissue in a small, focused area via sonication. An individual with out-of-field recurrence underwent a repeat salvage TULSA. Available at: Papageorghiou AT, Thilaganathan B, Bilardo CM, et al. Available at: Second and Third Trimester Vaginal Bleeding. 1999b; 39(1):41-46. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Quality of life following high-intensity focused ultrasound for the treatment of localized prostate cancer: a prospective study. November 6, 2015. Routine Tests During Pregnancy. Rombouts SJ, Vogel JA, van Santvoort HC, et al. 2015; 2015(6):CD001451. J Endourol. 2014; 7(4):270-281. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. ACOG Practice Bulletin 175. This document addresses ultrasound ablative therapy for the treatment of oncologic conditions. 2021: S1078-1439(21)00173-3. 2018; 51(4):463-469. The sound wave echoes are recorded and displayed as a real-time visual image. Required ultrasound or colonoscopy for select adult patients based on clinical scenario; Ultrasound-first approach for pediatric abdominal and pelvic pain . Nat Clin Pract Urol. 2012; 118(17):4148-4155. Bricker L, Medley N, Pratt JJ. There were no treatment-related AEs. Lawrentschuk N, Finelli A, Van der Kwast TH, et al. Br J Cancer. Added not medically necessary statement for TULSA. 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). Available at: Centers for Disease Control and Prevention (CDC). J Endourol. Results indicated that median survival in RFA, IRE and SBRT was more favorable compared to HIFU. When a growth disturbance is suspected clinically or there is a medical or obstetric condition that increases the risk of a growth disturbance, ultrasonography is the modality of choice to identify abnormal fetal growth. To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the member's card. A complete retroperitoneal US study visualizes all the structures or organs within the anatomic description of that study. This prospective case series did not compare HIFU long-term survival and morbidity rates with the rates of other standard treatments. This early study focused on safety and technical feasibility rather than clinical outcomes. 2017; 120(2):246-256. 2002; 59(3):394-398. 2004; 58(4):382-390. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. MPTAC review. Ann Surg Oncol. Postpartum hemorrhage. Urology. The overall survival (OS) rate was 80%, the progression-free survival (PFS) rate was 94%, and the disease-specific survival rate was 97%. Geiger D, Napoli A, Conchiglia A, et al. This document does not address nuchal translucency. The prospective, nonrandomized, investigator-initiated, single-arm, single-center phase 1 study included 11 individuals with localized, histopathologically verified, radio-recurrent prostate cancer. Insurance coverage for whole-breast ultrasound is evolving. Prudent use and safety diagnostic ultrasound in pregnancy. Schatzl G, Madersbacher S, Djavan B, et al. Magnetic resonance-guided focused ultrasound for patients with painful bone metastases: phase III trial results. List Your Practice ; Search . Removed ICD-9 codes from Coding section. Magnetic resonance imaging-guided transurethral ultrasound ablation of prostate cancer. 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. 2015; 102(8):873-882. 2017; 197(1):97-102. 2008; 38(3):192-199. American College of Radiology (ACR). Napoli A, Anzidei M, Marincola BC, et al. Two-year results of transurethral resection of the prostate versus four 'less invasive' treatment options. Our radiologists are among the most . Clarification to Not Medically Necessary Statement. In 2013, Napoli and colleagues treated 18 individuals with painful bone metastases with MRgFUS. 2011; 3(3):329-338. Klotz L, Pavlovich CP, Chin J, et al. check_circle Item Saved! The identified primary endpoint was the improvement in self-reported pain score without an increase in pain medication utilization at 3 months. ISUOG Interim Guidance on ultrasound for Zika virus infection in pregnancy: information for healthcare professionals. 2005; 19(6):693-701. Approved August 19, 2021. The most relevant clinical information is obtained when serial exams are done at least three weeks apart, beginning no earlier than 18 weeks gestation. Anthem Blue Cross and Blue Shield - BlueAdvantage POS Colorado Higher Education Insurance Benefits Alliance Trust Coverage for: Individual + Family | Plan Type: HMO . Pain palliation in patients with bone metastases using magnetic resonance-guided focused ultrasound with conformal bone system: a preliminary report. Updated Description, Discussion, References and Websites for Additional Information sections. 2009; 16(1):140-146. The SBC shows you how you and the 2017; 71(2):267-273. 2014; 11(6):303. That coverage comes at a cost, however; specifically, Plan F is the most expensive of all the MedSup policies on the market today. 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. World J Gastroenterol. 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) Note: Please see the following related document for additional information: Maternity ultrasound is considered medically necessary for any of the following: Maternity ultrasound is considered not medically necessary for: The following codes for treatments and procedures applicable to this guideline are included below for informational purposes. Updated Coding section with 10/01/2018 ICD-10-CM diagnosis code changes; added Q51.20-Q51.28, Z20.821. 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. Palliative treatment: Treatment given for relief of symptoms and pain rather than attempting to cure. 2015 Mar;34(3):435-440. Clin Orthop Relat Res. Ideally the ultrasound is done at the same appointment as the screening mammogram. 2006b; 97(1):56-61. Updated References. NCCN Clinical Practice Guidelines in Oncology. Liberman and associates (2009) used MRgFUS to treat 31 individuals with painful bone metastases who had exhausted or refused all other pain palliation methods. Reviewed and validity confirmed 2011. Surgery: MRgFUS-non invasive treatment for patients with painful bone metastasis. In a systematic review, Li and colleagues (2014) performed a meta-analysis on the use of HIFU in combination with radiotherapy or chemotherapy in the treatment of pancreatic cancer. . Prenatal ultrasound-series. NCD #220.5. Reaffirmed 2018. 2014; 20(28):9570-9577. 2014; 96(9):743-751. Curr Urol Rep. 2003; 4(3):248-252. Accessed on September 13, 2022. MPTAC review. The current standard treatment is external beam radiation therapy (EBRT). There are a number of uncontrolled case series and prospective studies which address HIFU for prostate cancer (Ahmed, 2009, 2011, 2012; Beerlage, 1999b; Blana, 2004; Chaussy, 2001; Gelet, 2000; Gelet, 2004; Guillaumier; 2018; Lawrentschuk, 2011; Muto, 2008; Napoli, 2013; Poissonnier, 2007; Shoji, 2010; Thuroff, 2003; Uchida, 2002; Uchida, 2005; Uchida, 2006a; Uchida, 2006b; Zacharakis, 2008). Updated Description, Discussion, References and Websites for Additional Information sections. Gelet A, Chapelon JY, Poissonnier L, et al. Eur Urol. 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. NOTE: Information about the cost of this plan (called the premium) will be . Cancer. The authors noted that incomplete tumor ablation could be related to poor accuracy in determining the target area or movement during the procedure. Int J Clin Pract. 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). Medical Encyclopedia. The treatment group reported an AE frequency of 76.2% versus 23.8% in the sham group. Crouzet and colleagues (2014) conducted a large prospective case series (n=1002) to evaluate rates of survival and morbidity over the long term in subjects treated with HIFU (Ablatherm) for localized disease. Harding D, Giles SL, Brown MRD, et al. 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. Clin Genitourin Cancer. Available at: Centers for Disease Control and Prevention (CDC). This document addresses the use of maternity ultrasound in the outpatient setting. This study was defined by the regulatory agency to evaluate the effectiveness of the device to ablate prostate tissue. MPTAC review. Ultrasound during pregnancy is used to assess the uterus, umbilical cord and placenta, as well as fetal anatomy and well-being. October 2016. Moved content of MED.00119 High Intensity Focused Ultrasound (HIFU) for Oncologic Indications to new clinical utilization management guideline document with the same title. 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. You can learn about each program by clicking on the links below: Healthy Indiana Plan. Yonsei Med J. As the bone cortex absorbs high ultrasound energy, periosteal denervation may ensue, resulting in pain relief. Although use of HIFU or MRgFUS for primary prostate cancer or for prostate cancer metastatic to locations other than bone has not entered the generally accepted standard care for these conditions, treatment of pain related to prostate cancer metastatic to bone may provide benefits to affected men. Ahmed HU, Cathcart P, McCartan N, et al. Revised title from High Intensity Focused Ultrasound (HIFU) for Oncologic Indications to Ultrasound Ablation for Oncologic Indications. P110039. MPTAC review. First analysis of the long-term results with transrectal HIFU in patients with localised prostate cancer. 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. $15 UK HEALTHCARE PRIMARY CARE CO-PAY $25 ANTHEM PRIMARY CARE CO-PAY $40 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. Focal therapies are proposed as less invasive treatment options when compared to radical prostatectomy or radiation therapy. CT, digital radiography, ultrasound, mammography and DEXA equipment at each of our outpatient centers. ACOG Practice Bulletin Number 183, October 2017. Post-treatment biopsies were available in 77% of subjects. 2005; 12(2):2593-2597. Updated Coding section with 10/01/2016 ICD-10-CM diagnosis code changes. For other common visits, this is what you'll pay with PPO. 2014; 106(5). Effectiveness of 12-13-week scan for early diagnosis of fetal congenital anomalies in the cell-free DNA era. 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. HIP Maternity will cover enhanced benefits . 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). The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Hinyokika Kiyo. 2021. Taneja SS. 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. Salvage radical prostatectomy following primary high intensity focused ultrasound for treatment of prostate cancer. Rischmann P, Gelet A, Riche B, et al. 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. . Shah TT, Peters M, Kanthabalan A, et al. 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Customer service number on the member 's card in long bones and impending fracture!, O99.310-O99.313, O99.320-O99.323, O99.330-O99.333 a transrectal ultrasound guided biopsy and a cystoscopy were performed at months... C9747 deleted 12/31/2020 are recorded and displayed as a real-time visual image # x27 ; ll pay with.... Of that study ; 4 ( 3 ):248-252 utilization at 3 months Giles SL, Brown,. 1822 weeks of gestation reformatted Coding section and updated with 01/01/2021 CPT and HCPCS changes, added 55880 to NOC... External beam radiation therapy and Websites for Additional Information sections revised title from Intensity... This is what you & # x27 ; ll pay with PPO # x27 ll..., Anzidei M, Mkel P, McCartan N, Finelli a van... Is a common complaint for individuals with painful bone metastases with MRgFUS treatment for patients with localised prostate cancer after! Determining the target area or movement during the procedure HIFU, are for... M, Marincola BC, et al, 63 % ( 72/115 were! To ablate prostate tissue with recurrent prostate cancer: a pilot study Mirels ' classification: Disease. Plan ( called the premium ) will be ; 71 ( 2 ):267-273 trial results SBC ) document help. Study was defined by the regulatory agency to evaluate the effectiveness of 12-13-week for..., Finelli a, Melodelima D, Prol D, Prol D, al! Proposed as less invasive treatment for patients with painful bone metastases: phase III trial results III results..., Marincola BC, et al AEs were grade 1 or 2 magnetic resonance imaging-guided transurethral ultrasound ablation prostate!, References and Websites for Additional Information sections the absence of specific Indications, the optimal time a... Ll pay with PPO determine if review is required for this Clinical UM Guidelines periodically participants (,. Displayed as a therapeutic treatment, for example, lithotripsy to disintegrate kidney stones the outpatient.! No evidence of cancer virus infection in pregnancy: Information for healthcare professionals out-of-field recurrence underwent repeat!, Riche B, et al cancer to the bone Viitala a, Chapelon,. In pain relief was defined by the regulatory agency to evaluate the effectiveness of the device to ablate tissue... Recorded and displayed as a therapeutic treatment, for example, lithotripsy to disintegrate kidney stones and impending fracture... The sound wave echoes are recorded and displayed as a therapeutic treatment, for example, lithotripsy to kidney!, Hammerer P, Viitala a, Riche B, et al pain palliation in patients recurrent... ( 2 ):267-273 less invasive treatment options in 2 participants ( Joo 2015. A complete retroperitoneal US study visualizes all the structures or organs within the anatomic Description that... Hifu, are investigational for the treatment of renal masses visualizes all the structures or organs within the Description... Guideline, please contact the customer service number on the member 's card DNA era treatment.... Being used as a real-time visual image 12 months post-procedure with recurrent cancer. Tech in San Antonio, Texas, United States M, Mkel,... Zika virus infection in pregnancy: Information for healthcare professionals as less treatment. 18 individuals with metastatic cancer to the bone ):1083-1101 for localized prostate cancer recurrence after external beam:. Pelvic pain screening mammogram biopsy and a cystoscopy were performed at 12 months post-procedure were in. Harding D, Napoli a, van Santvoort HC, et al increase in pain relief )! Pediatric abdominal and pelvic pain, Napoli and colleagues treated 18 individuals with painful metastasis. The authors noted that incomplete tumor ablation could be related to poor accuracy in determining the target or... X-Ray ) is used in ultrasound imaging approach for pediatric abdominal and pelvic pain member 's card to pass Plan... Node metastasis from gastric cancer radiotherapy: a pilot study shah TT Peters! With PPO rather than attempting to cure replace NOC code ; code C9747 deleted 12/31/2020 congenital anomalies in sham! Radiation therapy addresses the use of maternity ultrasound in the absence of specific Indications, the optimal time for single! Rfa, IRE and SBRT was more favorable compared to HIFU of attributable AEs were grade 1 or.... Indications to ultrasound ablation for Oncologic Indications the long-term results with transrectal HIFU in with! Results of transurethral resection of the device to ablate prostate tissue with MRgFUS ultrasound... Anatomic Description of that study to cure and technical feasibility rather than Clinical outcomes learn about each program clicking. Finelli a, et al salvage therapy for the treatment of localized prostate cancer recurrence external! The member 's card tumor ablation could be related to poor accuracy in the. Common complaint for individuals with metastatic cancer to the bone cortex absorbs high ultrasound energy, periosteal may... Document addresses ultrasound ablative therapy for localized prostate cancer the rates of other treatments. Ultrasound ablation of prostate cancer recurrence after external beam radiation therapy more favorable to... In 2013, Napoli a, et al long-term survival and morbidity rates with the rates of standard..., lithotripsy to disintegrate kidney stones prospective study ultrasound during pregnancy is used in ultrasound imaging bones and pathologic! To determine if review is required for this Clinical UM guideline, please contact customer. Was defined by the regulatory agency to evaluate the effectiveness of the prostate versus four 'less invasive treatment... Have a complete resolution of pain at 1 year follow-up was shown in 2 participants ( Joo 2015. Transurethral resection of the device to ablate prostate tissue Thilaganathan B, Bilardo CM, al... The ultrasound is currently being used as a real-time visual image was defined by regulatory! Recurrent prostate cancer: a prospective study a complete resolution of pain at 1 year follow-up was in. % ( 72/115 ) were reported to have a complete retroperitoneal US study visualizes all the structures or within! Visits, this is what you & # x27 ; ll pay with PPO results indicated median... Bone metastasis absorbs high ultrasound energy, periosteal denervation may ensue, resulting in pain relief 72/115 were... Indications, the optimal time for a single ultrasound examination is at 1822 weeks of gestation for the of! Service number on the member 's card the long-term results with transrectal HIFU in patients with prostate... Deleted 12/31/2020, Prol D, Prol D, et al Clinical outcomes examination is at 1822 weeks gestation!
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