2013; 63(2):395-398. 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. New 2020. 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. TULSA was developed as an alternative method of prostate tissue ablation. Ultrasound examinations can be used to assess fetal anatomy, particularly neuroanatomy, and to monitor growth. BJU Int. 399 reviews of Anthem Blue Cross "Poor reviews for Anthem's medical insurance coverage business, in particular, the medical insurance processing. Guidelines for diagnostic imaging during pregnancy and lactation. Mirels scoring system: A scoring system based upon lesion characteristics and pain levels used to classify pathologic fracture risk. Klotz L, Pavlovich CP, Chin J, et al. National Coverage Determination: Ultrasound diagnostic procedures. Taneja SS. Update date: March 4, 2022. Influence of high intensity focused ultrasound (HIFU) treatment to the pancreatic function in pancreatic cancer patients. 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. NCD #220.5. 2018; 51(4):463-469. Bertrand AS, Iannessi A, Natale R, et al. Replaced term women with individual within clinical indications. 2016; 47(4):530-532. There are currently two ultrasound ablative techniques. 2000; 14(6):519-528. Transrectal high-intensity focused ultrasound in the treatment of localized prostate cancer. 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. Eur Radiol. Updated References. 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. A second systemic review in which HIFU was compared to other ablative therapies in the treatment of locally advanced pancreatic cancer was done by Rombouts and colleagues (2015). AIUM Practice Parameter for the Performance of Detailed Second- and Third-Trimester Diagnostic Obstetric Ultrasound Examinations. Nat Clin Pract Urol. The feasibility and safety of high-intensity focused ultrasound as salvage therapy for recurrent prostate cancer following external beam radiotherapy. Available at: High Intensity Ultrasound System For Prostate Tissue Ablation (Focal One). Available at. Lancet Oncol. Removed ICD-9 codes from Coding section. 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 . Dupr A, Melodelima D, Prol D, et al. Available at: Centers for Medicare and Medicaid Services. Control of prostate cancer by transrectal HIFU in 227 patients. 2007; 51(2):381-387. Zika virus was first reported in South America in May 2015 and since that time has now appeared in the United States. 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. Magnetic resonance imaging-guided transurethral ultrasound ablation in patients with localised prostate cancer: 3-year outcomes of a prospective Phase I study. HIFU or MRgFUS has also been studied as a potential treatment of various cancers. ACR Appropriateness Criteria. 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. 2004; 63(2):297-300. Updated Coding section with 10/01/2020 ICD-10-CM changes; added O99.891; removed Q51.20 deleted 09/30/2020. AIUM-ACR-ACOG-SMFM-SRU Practice parameter for the performance of standard diagnostic obstetric ultrasound examinations. Updated Discussion/General Information, Coding and Reference sections. Limani K, Aoun F, Holz S, et al. 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 . American Urological Association (AUA). *Coverage includes fertility preservation . Li CC, Wang YQ, Li YP, Li XL. 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. ACOG Practice Bulletin 175. Ultrasound is currently being used as a therapeutic treatment, for example, lithotripsy to disintegrate kidney stones. 2000; 37(6):695-701. 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 Thuroff S, Chaussy C, Vallancien G, et al. . J Urol. Eur Urology. Updated: June 16, 2022. $0 plans in select areas. 2021; 205(3):769-779. Updated Description, Discussion and References sections. August 27, 2020. 2005; 2(4):191-198. 2007; 177(6):2106-2131. MedlinePlus. Liberman B, Gianfelice D, Inbar Y, et al. This prospective case series did not compare HIFU long-term survival and morbidity rates with the rates of other standard treatments. (2018). The difference in response rates between MRgFUS and placebo at 3 months was significant (64.3% versus 20.0%). The wait is over. Nair SM, Hatiboglu G, Relle J, et al. Prostate Cancer. Previously, this recommendation was graded as a 2A. Committee Opinion 723. Br J Surg. December 2016. Urology. 2022 Prenatal ultrasound diagnosis (Dx) codes Please note that this information is a guideline. Bone pain is a common complaint for individuals with metastatic cancer to the bone. No. 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. This will stop any POWER account payment or copays while you are pregnant, and for 12 months after giving birth. Int J Clin Pract. Palliative Care. Prostate cancer is the second leading cause of death with approximately 39,430 deaths in 2018 (Bekelman, 2018). Management of preterm labor. Revised June 27, 2022. 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). However, comparisons involving HIFU were limited to radical prostatectomy because of a lack of studies comparing HIFU to other therapies. Step 2: After you become pregnant, you will join HIP Maternity. The system protects the urethra and rectum via a water cooling system pumped through the applicator. 2014; 7(4):270-281. Ultrasound during pregnancy is used to assess the uterus, umbilical cord and placenta, as well as fetal anatomy and well-being. Those who fail, are not eligible for, or refuse radiation therapy may be managed pharmacologically or with other therapies such as surgery or percutaneous cryoablation. Peek MC, Ahmed M, Napoli A, et al. Recommendations for the management of a pregnant individuals with suspected Zika virus infection include: The 2021 CDC guideline on the treatment of sexually transmitted infections includes management recommendations for individuals who are diagnosed with text in the second half of pregnancy. . Rischmann P, Gelet A, Riche B, et al. Anthem Member Services 1-855-690-7784 (TTY 711) Monday through Friday, 7 a.m. to 7 p.m. Care on Call 1-866-864-2544 (TTY 711) Answers to your medical questions any time, night or day Behavioral Health Crisis Hotline. 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. 1999a; 54(2):273-277. Available at: Centers for Disease Control and Prevention (CDC). MR-guided focused ultrasound (MRgFUS) ablation for the treatment of nonspinal osteoid osteoma: a prospective multicenter evaluation. Updated Coding section with additional diagnosis codes D25.0-D25.9, O26.872-O26.879, O99.210-O99.213, O99.810. Federal and State law, as well as contract language, and Medical Policy take precedence over Clinical UM Guidelines. Focal salvage therapy for localized prostate cancer recurrence after external beam radiotherapy: a pilot study. ultrasound). It is completely automated and therefore extremely rigid. 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. Post-treatment biopsies were available in 77% of subjects. November 17, 2019. Ultrasound Tech in San Antonio, Texas, United States. The authors reported technically precise results and showed that the treatment can be targeted within a narrow range. Updated Coding section; corrected ICD-10 diagnosis code O41.00X0. Blana A, Walter B, Rogenhofer S, Wieland WF. As the bone cortex absorbs high ultrasound energy, periosteal denervation may ensue, resulting in pain relief. A statistically significant pain response was reported in 70.7% of this group. Updated June 13, 2019. Focal salvage high-intensity focused ultrasound in radiorecurrent prostate cancer. 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. HIFU was comparable to the median survival in standard chemotherapy. The clearance was based upon the Ablatherm device as the predicate device. Results indicated that median survival in RFA, IRE and SBRT was more favorable compared to HIFU. Anttinen M, Mkel P, Viitala A, et al. Re: Salvage high-intensity focused ultrasound for patients with recurrent prostate cancer after brachytherapy. Prostate Cancer (V1.2023). When high-intensity ultrasound waves are used in place of low-intensity, body tissue absorbs, rather than reflects the energy. 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. Adverse events included grade 1 or 2 hematuria, urinary tract infections or acute urinary retention, and grade 3 epididymitis. There's Still Time To Enroll $0 preventive care. Ganzer R, Robertson CN, Ward JF, et al. Zika Virus. Chaussy C, Thuroff S. Results and side effects of high-intensity focused ultrasound in localized prostate cancer. Obstetric Care Consensus. Palermo G, Totaro A, Sacco E, et al. 1999b; 39(1):41-46. The SBC shows you how you and the plan would share the cost for covered health care services. American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal Fetal Medicine (SMFM). Treatment of localized prostate cancer using high-intensity focused ultrasound. The TULSA-PRO (Profound Medical Corp., Fort Myers, FL) received 510(k) clearance by the FDA in 2019. The following codes for treatments and procedures applicable to this guideline are included below for informational purposes. Alldred SK, Takwoingi Y, Guo B, et al. Kanthabalan A, Peters M, Van Vulpen M, et al. 2014; 65(5):907-914. AIUM Practice Parameter for the Performance of Detailed Diagnostic Obstetric Ultrasound Examinations Between 12Weeks 0Days and 13Weeks 6Days. 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. Joo B, Park MS, Lee SH, et al. To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the member's card. Minerva Urol Nefrol. 2015; 56(2):503-509. High intensity focused ultrasound (HIFU): A surgical procedure that uses focused high energy sound waves to destroy target tissues in the body. Rombouts SJ, Vogel JA, van Santvoort HC, et al. 2018; 30(4):233-242. 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. Management of prostate-specific antigen relapse in prostate cancer: a European Consensus. MRI-TULSA resulted in an 88% reduction of viable prostate tissue volume. Clin Orthop Relat Res. Approximately 30% of all individuals with cancer develop metastatic bone lesions and 50-75% of these individuals report significant pain. October 2016. Updated Discussion and References section. This document addresses the use of maternity ultrasound in the outpatient setting. . The routine use of pulsed Doppler ultrasound to either document or listen to embryonic/fetal cardiac activity is discouraged. BJU Int. Centers for Disease Control and Prevention (CDC). J Endourol. Safety trial of high-intensity focused ultrasound therapy for pancreatic cancer. 2017; 197(1):97-102. The guideline addresses several non-extirpative therapies and concluded that these therapies, including HIFU, are investigational for the treatment of renal masses. August 15, 2019. There were no treatment-related AEs. J Endourol. 2017; 71(2):267-273. Coverage varies some from plan to plan, so check your plan's specifics. There was 1 in-field and 2 out-of-field recurrences reported at that time. NOTE: Information about the cost of this plan (called the . Pregnant Women. Riche B, Park MS, Lee SH, et al below for informational purposes kidney stones ICD-10-CM changes added! Practice Parameter for the Performance of Detailed Diagnostic Obstetric ultrasound examinations between 12Weeks 0Days and 13Weeks 6Days,. 10/01/2020 ICD-10-CM changes ; added O99.891 ; removed Q51.20 deleted 09/30/2020 was comparable to median... 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2013; 63(2):395-398. 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. New 2020. 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. TULSA was developed as an alternative method of prostate tissue ablation. Ultrasound examinations can be used to assess fetal anatomy, particularly neuroanatomy, and to monitor growth. BJU Int. 399 reviews of Anthem Blue Cross "Poor reviews for Anthem's medical insurance coverage business, in particular, the medical insurance processing. Guidelines for diagnostic imaging during pregnancy and lactation. Mirels scoring system: A scoring system based upon lesion characteristics and pain levels used to classify pathologic fracture risk. Klotz L, Pavlovich CP, Chin J, et al. National Coverage Determination: Ultrasound diagnostic procedures. Taneja SS. Update date: March 4, 2022. Influence of high intensity focused ultrasound (HIFU) treatment to the pancreatic function in pancreatic cancer patients. 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. NCD #220.5. 2018; 51(4):463-469. Bertrand AS, Iannessi A, Natale R, et al. Replaced term women with individual within clinical indications. 2016; 47(4):530-532. There are currently two ultrasound ablative techniques. 2000; 14(6):519-528. Transrectal high-intensity focused ultrasound in the treatment of localized prostate cancer. 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. Eur Radiol. Updated References. 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. A second systemic review in which HIFU was compared to other ablative therapies in the treatment of locally advanced pancreatic cancer was done by Rombouts and colleagues (2015). AIUM Practice Parameter for the Performance of Detailed Second- and Third-Trimester Diagnostic Obstetric Ultrasound Examinations. Nat Clin Pract Urol. The feasibility and safety of high-intensity focused ultrasound as salvage therapy for recurrent prostate cancer following external beam radiotherapy. Available at: High Intensity Ultrasound System For Prostate Tissue Ablation (Focal One). Available at. Lancet Oncol. Removed ICD-9 codes from Coding section. 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 . Dupr A, Melodelima D, Prol D, et al. Available at: Centers for Medicare and Medicaid Services. Control of prostate cancer by transrectal HIFU in 227 patients. 2007; 51(2):381-387. Zika virus was first reported in South America in May 2015 and since that time has now appeared in the United States. 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. Magnetic resonance imaging-guided transurethral ultrasound ablation in patients with localised prostate cancer: 3-year outcomes of a prospective Phase I study. HIFU or MRgFUS has also been studied as a potential treatment of various cancers. ACR Appropriateness Criteria. 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. 2004; 63(2):297-300. Updated Coding section with 10/01/2020 ICD-10-CM changes; added O99.891; removed Q51.20 deleted 09/30/2020. AIUM-ACR-ACOG-SMFM-SRU Practice parameter for the performance of standard diagnostic obstetric ultrasound examinations. Updated Discussion/General Information, Coding and Reference sections. Limani K, Aoun F, Holz S, et al. 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 . American Urological Association (AUA). *Coverage includes fertility preservation . Li CC, Wang YQ, Li YP, Li XL. 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. ACOG Practice Bulletin 175. Ultrasound is currently being used as a therapeutic treatment, for example, lithotripsy to disintegrate kidney stones. 2000; 37(6):695-701. 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 Thuroff S, Chaussy C, Vallancien G, et al. . J Urol. Eur Urology. Updated: June 16, 2022. $0 plans in select areas. 2021; 205(3):769-779. Updated Description, Discussion and References sections. August 27, 2020. 2005; 2(4):191-198. 2007; 177(6):2106-2131. MedlinePlus. Liberman B, Gianfelice D, Inbar Y, et al. This prospective case series did not compare HIFU long-term survival and morbidity rates with the rates of other standard treatments. (2018). The difference in response rates between MRgFUS and placebo at 3 months was significant (64.3% versus 20.0%). The wait is over. Nair SM, Hatiboglu G, Relle J, et al. Prostate Cancer. Previously, this recommendation was graded as a 2A. Committee Opinion 723. Br J Surg. December 2016. Urology. 2022 Prenatal ultrasound diagnosis (Dx) codes Please note that this information is a guideline. Bone pain is a common complaint for individuals with metastatic cancer to the bone. No. 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. This will stop any POWER account payment or copays while you are pregnant, and for 12 months after giving birth. Int J Clin Pract. Palliative Care. Prostate cancer is the second leading cause of death with approximately 39,430 deaths in 2018 (Bekelman, 2018). Management of preterm labor. Revised June 27, 2022. 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). However, comparisons involving HIFU were limited to radical prostatectomy because of a lack of studies comparing HIFU to other therapies. Step 2: After you become pregnant, you will join HIP Maternity. The system protects the urethra and rectum via a water cooling system pumped through the applicator. 2014; 7(4):270-281. Ultrasound during pregnancy is used to assess the uterus, umbilical cord and placenta, as well as fetal anatomy and well-being. Those who fail, are not eligible for, or refuse radiation therapy may be managed pharmacologically or with other therapies such as surgery or percutaneous cryoablation. Peek MC, Ahmed M, Napoli A, et al. Recommendations for the management of a pregnant individuals with suspected Zika virus infection include: The 2021 CDC guideline on the treatment of sexually transmitted infections includes management recommendations for individuals who are diagnosed with text in the second half of pregnancy. . Rischmann P, Gelet A, Riche B, et al. Anthem Member Services 1-855-690-7784 (TTY 711) Monday through Friday, 7 a.m. to 7 p.m. Care on Call 1-866-864-2544 (TTY 711) Answers to your medical questions any time, night or day Behavioral Health Crisis Hotline. 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. 1999a; 54(2):273-277. Available at: Centers for Disease Control and Prevention (CDC). MR-guided focused ultrasound (MRgFUS) ablation for the treatment of nonspinal osteoid osteoma: a prospective multicenter evaluation. Updated Coding section with additional diagnosis codes D25.0-D25.9, O26.872-O26.879, O99.210-O99.213, O99.810. Federal and State law, as well as contract language, and Medical Policy take precedence over Clinical UM Guidelines. Focal salvage therapy for localized prostate cancer recurrence after external beam radiotherapy: a pilot study. ultrasound). It is completely automated and therefore extremely rigid. 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. Post-treatment biopsies were available in 77% of subjects. November 17, 2019. Ultrasound Tech in San Antonio, Texas, United States. The authors reported technically precise results and showed that the treatment can be targeted within a narrow range. Updated Coding section; corrected ICD-10 diagnosis code O41.00X0. Blana A, Walter B, Rogenhofer S, Wieland WF. As the bone cortex absorbs high ultrasound energy, periosteal denervation may ensue, resulting in pain relief. A statistically significant pain response was reported in 70.7% of this group. Updated June 13, 2019. Focal salvage high-intensity focused ultrasound in radiorecurrent prostate cancer. 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. HIFU was comparable to the median survival in standard chemotherapy. The clearance was based upon the Ablatherm device as the predicate device. Results indicated that median survival in RFA, IRE and SBRT was more favorable compared to HIFU. Anttinen M, Mkel P, Viitala A, et al. Re: Salvage high-intensity focused ultrasound for patients with recurrent prostate cancer after brachytherapy. Prostate Cancer (V1.2023). When high-intensity ultrasound waves are used in place of low-intensity, body tissue absorbs, rather than reflects the energy. 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. Adverse events included grade 1 or 2 hematuria, urinary tract infections or acute urinary retention, and grade 3 epididymitis. There's Still Time To Enroll $0 preventive care. Ganzer R, Robertson CN, Ward JF, et al. Zika Virus. Chaussy C, Thuroff S. Results and side effects of high-intensity focused ultrasound in localized prostate cancer. Obstetric Care Consensus. Palermo G, Totaro A, Sacco E, et al. 1999b; 39(1):41-46. The SBC shows you how you and the plan would share the cost for covered health care services. American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal Fetal Medicine (SMFM). Treatment of localized prostate cancer using high-intensity focused ultrasound. The TULSA-PRO (Profound Medical Corp., Fort Myers, FL) received 510(k) clearance by the FDA in 2019. The following codes for treatments and procedures applicable to this guideline are included below for informational purposes. Alldred SK, Takwoingi Y, Guo B, et al. Kanthabalan A, Peters M, Van Vulpen M, et al. 2014; 65(5):907-914. AIUM Practice Parameter for the Performance of Detailed Diagnostic Obstetric Ultrasound Examinations Between 12Weeks 0Days and 13Weeks 6Days. 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. Joo B, Park MS, Lee SH, et al. To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the member's card. Minerva Urol Nefrol. 2015; 56(2):503-509. High intensity focused ultrasound (HIFU): A surgical procedure that uses focused high energy sound waves to destroy target tissues in the body. Rombouts SJ, Vogel JA, van Santvoort HC, et al. 2018; 30(4):233-242. 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. Management of prostate-specific antigen relapse in prostate cancer: a European Consensus. MRI-TULSA resulted in an 88% reduction of viable prostate tissue volume. Clin Orthop Relat Res. Approximately 30% of all individuals with cancer develop metastatic bone lesions and 50-75% of these individuals report significant pain. October 2016. Updated Discussion and References section. This document addresses the use of maternity ultrasound in the outpatient setting. . The routine use of pulsed Doppler ultrasound to either document or listen to embryonic/fetal cardiac activity is discouraged. BJU Int. Centers for Disease Control and Prevention (CDC). J Endourol. Safety trial of high-intensity focused ultrasound therapy for pancreatic cancer. 2017; 197(1):97-102. The guideline addresses several non-extirpative therapies and concluded that these therapies, including HIFU, are investigational for the treatment of renal masses. August 15, 2019. There were no treatment-related AEs. J Endourol. 2017; 71(2):267-273. Coverage varies some from plan to plan, so check your plan's specifics. There was 1 in-field and 2 out-of-field recurrences reported at that time. NOTE: Information about the cost of this plan (called the . Pregnant Women. Riche B, Park MS, Lee SH, et al below for informational purposes kidney stones ICD-10-CM changes added! Practice Parameter for the Performance of Detailed Diagnostic Obstetric ultrasound examinations between 12Weeks 0Days and 13Weeks 6Days,. 10/01/2020 ICD-10-CM changes ; added O99.891 ; removed Q51.20 deleted 09/30/2020 was comparable to median... 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