Albisinni S, Aoun F, Bellucci S, et al. Day 1 health insurance coverage and comprehensive benefits options 401(k) matching program The SBC shows you how you and the plan would share the cost for covered health care services. ; AUA Prostate Cancer Clinical Guideline Update Panel. Participants included those who could not undergo or refused all other available options for pain palliation. They determined that Cloyd had ovarian cysts, not appendicitis. Whitworth M, Bricker L, Mullan C. Ultrasound for fetal assessment in early pregnancy. Participants were followed for up to 5 years post-procedure. 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. Reviewed and validity confirmed 2011. Due to variances in utilization patterns, each plan may choose whether to adopt a particular Clinical UM Guideline. Clin Orthop Relat Res. 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. Mirels scoring system: A scoring system based upon lesion characteristics and pain levels used to classify pathologic fracture risk. TULSA has been proposed as a localized treatment of unilateral intermediate risk prostate cancers in individuals not interested in active surveillance (Klotz, 2021). 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. PSA nadir as a predictive factor for biochemical disease-free survival and overall survival following whole-gland salvage HIFU following radiotherapy failure. High-intensity focused ultrasound for treatment of pancreatic cancer: a systematic review. When services are Not Medically Necessary:For the procedure and diagnosis codes listed above when criteria are not met. Blana A, Murat FJ, Walter B, et al. Geiger D, Napoli A, Conchiglia A, et al. Effects of high-intensity focused ultrasound for treatment of abdominal lymph node metastasis from gastric cancer. No. Int J Clin Pract. Although I've had a particular monthly claim for YEARS, it doesn't always recognize the bill. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. 2010; 468(10):2825-2827. High-intensity focused ultrasound and localized prostate cancer: efficacy results from the European multicentric study. Uchida T, Tomonaga T, Kim H, et al. HIFU was comparable to the median survival in standard chemotherapy. 2021; 35(4):497-505. The price of a diagnostic mammogram averages from $172 under Medicare to $239 with private insurance. Salvage high-intensity focused ultrasound for patients with recurrent prostate cancer after brachytherapy. The uterus, cervix, adnexa, and cul-de-sac region should be examined. Prostate Cancer (V1.2023). Prostate Cancer. Updated Discussion/General Information and Reference sections. Cochrane Database Syst Rev. Bone metastasis: When cancer cells have broken off from the primary tumor and have settled and started growing on bones. 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. Poggenpoel EJ, Geerts LT, Theron GB. Coverage varies some from plan to plan, so check your plan's specifics. American College of Obstetricians and Gynecologists (ACOG). Anthem has begun denying coverage for . The mean follow-up period was 6.4 years (range, 0.2-13.9). 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. In addition to the active and pending Medical Policies, BCBSIL has included policies which are under development or being revised. First trimester ultrasound tests alone or in combination with first trimester serum tests for Down's syndrome screening. Chin JL, Billia M, Relle J, et al. Updated Coding section with 10/01/2022 ICD-10-CM changes; added O35.00X0-O35.9XX9 replacing O35.0XX0-O35.9XX9. NOTE: Information about the cost of this plan (called the . 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. ACOG Practice Bulletin 175. Urology. 2022 Prenatal ultrasound diagnosis (Dx) codes Please note that this information is a guideline. Available at: U.S. National Library of Medicine. Single high intensity focused ultrasound session as a whole gland primary treatment for clinically localized prostate cancer: 10-year outcomes. Available at: Second and third trimester screening for fetal anomaly. The SBC shows you how you and the 2014; 84(5):1157-1162. Review January 10, 2022. These options carry their own risks and side effects. Reaffirmed 2018. Pain palliation for localized metastatic bone pain. The 2021 American Urological Association (AUA) published a guideline on renal mases and localized renal cancer. Moved content of MED.00119 High Intensity Focused Ultrasound (HIFU) for Oncologic Indications to new clinical utilization management guideline document with the same title. Siddiqui KM, Billia M, Arifin A, et al. The value of adding a universal booking scan to an existing protocol of routine mid-gestation ultrasound scan. 2017; 71(2):267-273. 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. Replaced term women with individual within clinical indications. Joo B, Park MS, Lee SH, et al. MPTAC review. November 6, 2015. Initial document development. A total of 22 individuals participated in the follow-up. Revised September 16, 2022. In addition, there are limitations on tissue tolerance at sites previously irradiated. 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. 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. 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. This guideline was reviewed and validated in 2011. Twelve-month prostate volume reduction after MRI-guided transurethral ultrasound ablation of the prostate. Quality of life following high-intensity focused ultrasound for the treatment of localized prostate cancer: a prospective study. 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. 2015 Mar;34(3):435-440. P110039. Zacharakis E, Ahmed HU, Ishaq A, et al. It is completely automated and therefore extremely rigid. 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. There were no reported treatment related severe adverse events (AEs). Updated Coding section; corrected ICD-10 diagnosis code O41.00X0. CPT Only - American Medical Association, MED.00057 MRI Guided High Intensity Focused Ultrasound Ablation for Non-Oncologic Indications, CG-SURG-61 Cryosurgical, Radiofrequency or Laser Ablation to Treat Solid Tumors Outside the Liver, https://acsearch.acr.org/docs/69397/Narrative, https://www.auanet.org/guidelines-and-quality/guidelines/renal-mass-and-localized-renal-cancer-evaluation-management-and-follow-up, https://www.astro.org/uploadedFiles/_MAIN_SITE/Patient_Care/Clinical_Practice_Statements/Content_Pieces/ClinicallyLocalizedProstateCancer.pdf, https://www.accessdata.fda.gov/cdrh_docs/pdf15/k153023.pdf, https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K172721, https://www.accessdata.fda.gov/cdrh_docs/pdf19/K191200.pdf, https://www.accessdata.fda.gov/cdrh_docs/pdf11/p110039b.pdf, http://www.cancer.org/treatment/understandingyourdiagnosis/bonemetastasis/bone-metastasis-treating-problems-caused, http://www.cdc.gov/cancer/prostate/basic_info/treatment.htm, https://medlineplus.gov/prostatecancer.html, https://www.nlm.nih.gov/medlineplus/palliativecare.html. Jawad MU, Scully SP. Radiother Oncol. Elterman D, Li W, Hatiboglu G, et al. Bone metastases are common in breast and prostate cancer (Liberman, 2009). 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 The feasibility and safety of high-intensity focused ultrasound as salvage therapy for recurrent prostate cancer following external beam radiotherapy. In the obese patient, expectations regarding visualization of fetal anatomy should be tempered. According to the FDA labeling, a nonunion is considered to be established when the fracture site shows no visibly progressive signs of healing. The remaining 11.1% (2/18) reported pain reoccurrence which required pharmacological care.
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