anthem ultrasound coveragearturo moreno accomplishments

The 2021 American Urological Association (AUA) published a guideline on renal mases and localized renal cancer. November 6, 2015. Zacharakis E, Ahmed HU, Ishaq A, et al. Zhang M, Liu L, Wang J, et al. Assess significant discrepancy between uterine size and dates; Follow-up for observation of identified fetal or cord anomaly; Evaluate suspected fetal growth abnormality (either growth restriction or macrosomia), and to follow proven or suspected intrauterine growth restriction; Confirm suspected or follow confirmed diagnosis of polyhydramnios or oligohydramnios; Estimate fetal weight or presentation in premature rupture of membranes or preterm labor; Serial evaluation of fetal growth in multi-fetal pregnancy. 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. AIUM practice guideline for the performance of obstetric ultrasound examinations. MedlinePlus. Update date: March 4, 2022. HIP Maternity will cover enhanced benefits . Centers for Disease Control and Prevention (CDC). J Urol. In brief: classifications in brief: Mirels' classification: metastatic disease in long bones and impending pathologic fracture. Moved content of MED.00119 High Intensity Focused Ultrasound (HIFU) for Oncologic Indications to new clinical utilization management guideline document with the same title. 2021; 205(3):769-779. 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. Available at: U.S. National Library of Medicine. Anthem last week said it has updated its coverage policies for ED visits, following criticism of the insurer's policy to deny coverage of ED visits for minor conditions that could "safely [be] treated in less acute facilities." Learn more: Get the primers for reducing avoidable ED utilization Background Pickles T, Goldenberg L, Steinhoff G. Technology review: high-intensity focused ultrasound for prostate cancer. The doctors in the emergency room did multiple tests including a CT scan and ultrasound. Reformatted Coding section. Rejection notice to me (if I'm lucky) and I start over. AIUM Practice Parameter for the Performance of Limited Obstetric Ultrasound Examinations by Advanced Clinical Providers. Boccon-Gibod L, Djavan WB, Hammerer P, et al. The American College of Obstetricians and Gynecologists (ACOG) 2018 Practice Bulletin Ultrasound in Pregnancy lists the following recommendations: The following conclusions are based on good and consistent evidence (Level A): The following conclusions are based on limited or inconsistent evidence (Level B): The following conclusion and recommendation are based primarily on consensus and expert opinion (Level C): The American College of Radiology (ACR), the American Institute of Ultrasound in Medicine (AIUM), ACOG, the Society for Maternal Fetal Medicine (SMFM), and the Society of Radiologists in Ultrasound (SRU) practice parameter (2018) notes: A standard obstetrical ultrasound examination in the first trimester includes evaluation of the presence, size, location, and number of gestational sac(s). The SBC shows you how you and the plan would share the cost for covered health care services. Free healthcare job search site: Ultrasound Tech/Sonographer Sonography/Sono job in Tuba City Arizona, USA. 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. Bone metastases are common in breast and prostate cancer (Liberman, 2009). Ultrasound Obstet Gynecol. 2010; 468(10):2825-2827. J Natl Cancer Inst. Available at: Limited obstetrical ultrasound examination. Ahmed HU, Zacharakis E, Dudderidge T, et al. NCCN Clinical Practice Guidelines in Oncology. An mpMRI, a transrectal ultrasound guided biopsy and a cystoscopy were performed at 12 months post-procedure. 2017. We reserve the right to review and update Clinical UM Guidelines periodically. 2010; 468(10):2825-2827. In 2015, The U.S. Food and Drug Administration (FDA) approved two devices for use in prostate cancer. Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline. This recommendation is based upon prospective and retrospective studies (Ahmed, 2012; Baco, 2014; Crouzet, 2012; Crouzet, 2017; Kanthabalan, 2017; Palermo, 2017; Rischmann, 2017; Shah, 2016; Siddiqui, 2016; Uddin 2012). Alternatively, the reduced tumor mass caused by thermal ablation may have an analgesic effect. Urology. Step 1: Report your pregnancy to your health plan. There were 12 grade 3 adverse events (AEs) attributable to the TULSA-PRO, all of which were resolved by 12 months. This document addresses ultrasound ablative therapy for the treatment of oncologic conditions. This guideline was reviewed and validated in 2011. This document addresses the use of maternity ultrasound in the outpatient setting. The bone metastases arose from a variety of primary tumors including renal, colorectal, lung, breast and prostate. Invest Radiol. Updated References section. Eur Urol. J Endourol. Uchida T, Ohkusa H, Yamashita H, et al. August 15, 2019. August 27, 2020. 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. 2015; 102(3):182-193. Nair SM, Hatiboglu G, Relle J, et al. Updated June 13, 2019. Summary of Safety and Effectiveness Data (SSED). Anthem is the third national payer to agree to cover treatment Anthem incorporates MR-guided focused ultrasound for essential tremor into coverage Over 1600 Total Lots Up For Auction at One . Approximately 98% of subjects received 1 (60%) or 2 treatments (38%). 2015; 2015(6):CD001451. 2019; 29(1):299-308. In the obese patient, expectations regarding visualization of fetal anatomy should be tempered. Primary pain palliation and local tumor control in bone metastases treated with magnetic resonance-guided focused ultrasound. Replaced term women with individual within clinical indications. J Endourol. ACOG Practice Bulletin 175. Available at: Antepartum Fetal surveillance. Evaluation of quality of life outcomes following palliative treatment of bone metastases with magnetic resonance-guided high intensity focused ultrasound: an international multicentre study. World J Gastroenterol. Eur Urol. $15 UK HEALTHCARE PRIMARY CARE CO-PAY $25 ANTHEM PRIMARY CARE CO-PAY $40 Bonekamp and associates (2019) performed a quantitative analysis of viable prostate tissue volume reduction at 12 months post-procedure. Ultrasound Tech in San Antonio, Texas, United States. In addition to the active and pending Medical Policies, BCBSIL has included policies which are under development or being revised. In brief: classifications in brief: Mirels' classification: metastatic disease in long bones and impending pathologic fracture. Focal salvage high-intensity focused ultrasound in radiorecurrent prostate cancer. Eur Radiol. No ionizing radiation (x-ray) is used in ultrasound imaging. Poggenpoel EJ, Geerts LT, Theron GB. 2014; 20(28):9570-9577. Obstetric Care Consensus. Shoji S, Nakano M, Nagata Y, et al. 2014; 84(5):1157-1162. As the bone cortex absorbs high ultrasound energy, periosteal denervation may ensue, resulting in pain relief. Addition of cell-free fetal deoxyribonucleic acid (DNA) screening for aneuploidy to Medically Necessary Statement. A clinically significant biopsy was reported in 34% (10/29) of participants with 59% (17/29) of participants reporting any positive biopsy. The clearance was based upon the Ablatherm device as the predicate device. American College of Obstetricians and Gynecologists (ACOG). Anthem Blue Cross Blue Shield: Health Insurance, Medicare & More Learn more about your coverage options after the Public Health Emergency (PHE) ends. Government Agency, Medical Society, and Other Authoritative Publications: The use of specific product names is illustrative only. Locally recurrent prostate cancer after initial radiation therapy: early salvage high-intensity focused ultrasound improves oncologic outcomes. Updated Coding section with 10/01/2022 ICD-10-CM changes; added O35.00X0-O35.9XX9 replacing O35.0XX0-O35.9XX9. It is completely automated and therefore extremely rigid. 2003; 17(8):673-677. J Ultrasound Med 2013; 32(6):1083-1101. Blana A, Walter B, Rogenhofer S, Wieland WF. Medical Encyclopedia. Uchida T, Sanghvi NT, Gardner TA, et al. 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. Harding D, Giles SL, Brown MRD, et al. Blana A, Murat FJ, Walter B, et al. Plans include prescription drug and behavioral health coverage as well as telemedicine services and free AirMed medical transportation. 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%). Of note, 65.7% (23/35) of individuals in the placebo group did not complete the 3-month follow-up compared to approximately 21% (26/112) of the MRgFUS group. 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. In an intent-to-treat analysis, 63% (72/115) were reported to have a complete histological response and had no evidence of cancer. In a statement, Anthem says, "Anthem health plans cover 222 contraceptive products at $0 cost share on our ACA Preventive List." The company went on to say that it covers "at least one product" in . 2009; 16(1):140-146. Crouzet S, Murat FJ, Pommier P, et al. This study was defined by the regulatory agency to evaluate the effectiveness of the device to ablate prostate tissue. When services are Not Medically Necessary:For the procedure and diagnosis codes listed above when criteria are not met. Magnetic resonance imaging-guided transurethral ultrasound ablation in patients with localised prostate cancer: 3-year outcomes of a prospective Phase I study. Whole-gland salvage high-intensity focused ultrasound therapy for localized prostate cancer recurrence after external beam radiation therapy. Thompson I, Thrasher JB, Aus G, et al. Limani K, Aoun F, Holz S, et al. 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. Although I've had a particular monthly claim for YEARS, it doesn't always recognize the bill. 2000; 4(3):183-187. Researchers used the visual analog pain score (VAS) to measure pain levels. Transrectal high-intensity focused ultrasound in the treatment of localized prostate cancer. CPT codes Dx codes 76801 76802 D25, D25.0, D25.1, D25.2, D25.9, O0900, O0901, O0902, O0903, O09511, O09512, November 17, 2019. Baco E, Gelet A, Crouzet S, et al. 2012; 105(2):198-202. 2017; 71(2):267-273. Uddin Ahmed H, Cathcart P, Chalasani V, et al. Available at: Centers for Medicare and Medicaid Services. 2011; 108(8 Pt 2):E196-E201. Cancer. Cochrane Database Syst Rev. The feasibility and safety of high-intensity focused ultrasound as salvage therapy for recurrent prostate cancer following external beam radiotherapy. Updated Coding section; corrected ICD-10 diagnosis code O41.00X0. 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. 2012; 118(12):3071-3078. The maternal cervix and adnexa should be examined. Magnetic resonance-guided focused ultrasound for patients with painful bone metastases: phase III trial results. High-intensity focused ultrasound for treatment of pancreatic cancer: a systematic review. . 2021: S1078-1439(21)00173-3. Summary of coverage and benefits PDF Service coverage and costs All employee health insurance plans provide one annual preventive care visit with your primary care provider at $0 co-pay within specified networks. Joo B, Park MS, Lee SH, et al. Gelet A, Chapelon JY, Poissonnier L, et al. The price of a diagnostic mammogram averages from $172 under Medicare to $239 with private insurance. Contact us today for information about Anthem or for questions regarding Medicaid programs and coverage. 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. The authors noted that incomplete tumor ablation could be related to poor accuracy in determining the target area or movement during the procedure. Ultrasound, the use of low-intensity sound waves to produce images, is an established diagnostic tool. 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. The resulting heat and cavitation destroys the targeted tissue. Jpn J Clin Oncol. 1999a; 54(2):273-277. BJU Int. Guideline for the management of clinically localized prostate cancer: 2007 update. The primary endpoint was achieved in 96% (110/115) of participants. 2015; 56(2):503-509. However, the change from baseline in MEDD intake was not statistically significant, although the authors noted a trend towards a statistically significant change. 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. Focal high intensity focused ultrasound of unilateral localized prostate cancer: a prospective multicentric hemiablation study of 111 patients. 2011; 185(3):862-868. Medical Policy & Technology Assessment Committee (MPTAC) review. 2015; 102(8):873-882. 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