Find top doctors who perform Rectal Ultrasound near you in Anthem, AZ. The following codes for treatments and procedures applicable to this guideline are included below for informational purposes. Curr Urol Rep. 2003; 4(3):248-252. Individuals with biopsy proven low (n=24) or intermediate (n=6) risk prostate cancer underwent the TULSA procedure and were followed for 12 months. Can J Urol. A total of 22 individuals participated in the follow-up. BJU Int. Updated Coding, Description, Discussion/General Information, and References. Alternatively, the reduced tumor mass caused by thermal ablation may have an analgesic effect. Updated Description, Discussion, References and Websites for Additional Information sections. Updated June 13, 2019. Ultrasound during pregnancy is used to assess the uterus, umbilical cord and placenta, as well as fetal anatomy and well-being. Last Revised March 16, 2022. 1999a; 54(2):273-277. MPTAC review. November 17, 2019. An obstetrical ultrasound in the second or third trimester includes an evaluation of fetal number, cardiac activity, presentation, amniotic fluid volume, placental position, fetal biometry, and an anatomic survey. 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). Available at. Government Agency, Medical Society, and Other Authoritative Publications: Maternal UltrasoundObstetricPrenatalSonography. Available at: U.S. National Library of Medicine. 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,. The mean follow-up period was 6.4 years (range, 0.2-13.9). 2021; 127(5):544-552. 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 mean reduction in the NRS score was significant between MRgFUS and placebo (3.6 3.1 versus 0.7 2.4). Last Reviewed: August 25, 2022. Crouzet S, Murat FJ, Pommier P, et al. 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). Taneja SS. 2015; 2015(6):CD001451. Treatment of localized prostate cancer using high-intensity focused ultrasound. New reimbursement policy: Maternity Services and Multiple Delivery (Professional) Beginning with dates of service on or after December 1, 2019, Anthem's current Routine Obstetrics policy will be retired and will be replaced by the new Maternity Services policy and the new Multiple Delivery policy. Chin JL, Billia M, Relle J, et al. 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. These results were not included in the primary efficacy analysis. 2011; 185(3):862-868. In the absence of specific indications, the optimal time for a single ultrasound examination is at 1822 weeks of gestation. Prenatal ultrasound-series. Sofuni A, Moriyasu F, Sano T, et al. Yonsei Med J. Updated Discussion, References and Websites for Additional Information sections. Yutkin V, Ahmed HU, Donaldson I, et al. An individual with out-of-field recurrence underwent a repeat salvage TULSA. J Endourol. To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the member's card. There were no reported treatment related severe adverse events (AEs). November 6, 2015. 2014; 2014:186782. Focal therapy for localised unifocal and multifocal prostate cancer: a prospective development study. 2017; 119(6):896-904. MPTAC review. CPT codes Dx codes 76801 76802 D25, D25.0, D25.1, D25.2, D25.9, O0900, O0901, O0902, O0903, O09511, O09512, 2001; 15(4):437-440. 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. Government Agency, Medical Society, and Other Authoritative Publications: The use of specific product names is illustrative only. Beerlage HP, Thuroff S, Debruyne FM, et al. 2002; 59(3):394-398. HIFU or MRgFUS has also been studied as a potential treatment of various cancers. 2022 Prenatal ultrasound diagnosis (Dx) codes Please note that this information is a guideline. The SBC shows you how you and the plan would share the cost for covered health care services. At 12 months, the majority of participants (10/11) were cancer free in the ablated area and maintained a low stable PSA. There were no treatment-related AEs. Gelet A, Chapelon JY, Bouvier R, et al. BJU Int. Comprehensive medical coverage that covers many common services at no cost or for a low copay. AIUM Practice Parameter for the Performance of Detailed Diagnostic Obstetric Ultrasound Examinations Between 12Weeks 0Days and 13Weeks 6Days. Ann Surg Oncol. Magnetic resonance imaging-guided transurethral ultrasound ablation in patients with localised prostate cancer: 3-year outcomes of a prospective Phase I study. Routine Tests During Pregnancy. The price of a diagnostic mammogram averages from $172 under Medicare to $239 with private insurance. 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. Birth Defects Homepage: Diagnosis. 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. Initial document development. You bet! Screening for Fetal Aneuploidy. Updated Description, Coding, Discussion and References sections. Zika Virus. 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). At 2 weeks follow-up, all individuals experienced a decrease in VAS pain scores from baseline (1.5-5). This document addresses ultrasound ablative therapy for the treatment of oncologic conditions. Systematic review of high-intensity focused ultrasound ablation in the treatment of breast cancer. Our radiologists are among the most . Individuals received either whole gland (n=8) or partial (n=8) ablation. The remaining 11.1% (2/18) reported pain reoccurrence which required pharmacological care. Liberman B, Gianfelice D, Inbar Y, et al. 2021; 35(4):497-505. Breast MRI costs an average $615 under Medicare . J Bone Joint Surg Am. ACOG Practice Bulletin 163. The updated file enables providers to separately bill for the professional component (26) and the technical component (TC). Pain severity was further reduced at the 3-month follow-up to 1 (SD 1.1) (0-3; 95% CI, 0-1.85) (p=0.001). Adverse events included grade 1 or 2 hematuria, urinary tract infections or acute urinary retention, and grade 3 epididymitis. Uchida T, Baba S, Irie A, et al. The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Addition of cell-free fetal deoxyribonucleic acid (DNA) screening for aneuploidy to Medically Necessary Statement. In addition to the active and pending Medical Policies, BCBSIL has included policies which are under development or being revised. The prospective, nonrandomized, investigator-initiated, single-arm, single-center phase 1 study included 11 individuals with localized, histopathologically verified, radio-recurrent prostate cancer. Indiana Medicaid provides coverage to pregnant women through two programs. J Evid Based Med. 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. BJU Int. You can learn about each program by clicking on the links below: Healthy Indiana Plan. The sound wave echoes are recorded and displayed as a real-time visual image. . 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. Reformatted Coding section. 2018; 30(4):233-242. Mol Urol. 2006a; 13(3):228-233. In October 2017, ACOG and SMFM released an updated version of the practice advisory based upon updated Centers for Disease Control and Prevention (CDC) recommendations and recently published guidance. This document does not address nuchal translucency. Practice Advisory Interim Guidance for Care of Obstetric Patients During a Zika Virus Outbreak. 2020; 22:79-87. The treatment group reported an AE frequency of 76.2% versus 23.8% in the sham group. Blana A, Walter B, Rogenhofer S, Wieland WF. 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. Prostate cancer is the second leading cause of death with approximately 39,430 deaths in 2018 (Bekelman, 2018). Prostate Cancer (V1.2023). These options carry their own risks and side effects. 2017. 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. National Coverage Determination: Ultrasound diagnostic procedures. Ultrasound averages range from $54 to $100. The authors reviewed 9 studies with a total of 167 participants. Rooms for rent in Bury flat and house shares - 3 currently available. Eur Urology. grievance or appeal. 2016; 19(3):311-316. J Endourol. 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 Statement on Biological Effects of Ultrasound in Vivo. 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. We are now accepting all Anthem Blue Cross Blue Shield patients. Gardner TA, Koch MO. 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. NOTE: Information about the cost of this plan (called the . ; AUA Prostate Cancer Clinical Guideline Update Panel. In 2013, Napoli and colleagues treated 18 individuals with painful bone metastases with MRgFUS. Search doctors, conditions, or procedures . Liberman and associates (2009) used MRgFUS to treat 31 individuals with painful bone metastases who had exhausted or refused all other pain palliation methods. There's Still Time To Enroll $0 preventive care. Pickles T, Goldenberg L, Steinhoff G. Technology review: high-intensity focused ultrasound for prostate cancer. Ultrasound imaging can be used after delivery to evaluate abnormalities of the reproductive and adjacent structures. A complete resolution of pain at 1 year follow-up was shown in 2 participants (Joo, 2015). Updated grammar in medically necessary statement regarding maternal risk factors from including but not limited to, hypertension, diabetes, sickle cell disease preeclampsia), substance abuse, or hyperemesis gravidarum to including but not limited to, hypertension, diabetes or sickle cell disease), preeclampsia, substance abuse or hyperemesis gravidarum. World J Gastroenterol. Ahmed HU, Zacharakis E, Dudderidge T, et al. A complete retroperitoneal US study visualizes all the structures or organs within the anatomic description of that study. 2017; 120(2):246-256. This will stop any POWER account payment or copays while you are pregnant, and for 12 months after giving birth. * Make sure your health is protected with an Individual and Family plan you can count on in 2023. The benefits and limitations of ultrasonography should be discussed with all patients. Lancet Oncol. However, there are no data specific to congenital Zika virus infection to guide recommendations for timing of serial ultrasounds; ob-gyns and other obstetric providers may consider extending the time interval between ultrasounds in accordance with patient preferences and clinical judgement. As the bone cortex absorbs high ultrasound energy, periosteal denervation may ensue, resulting in pain relief. Contact us today for information about Anthem or for questions regarding Medicaid programs and coverage. High-intensity focused ultrasound in the treatment of primary prostate cancer: the first UK series. BJU Int. 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. Transrectal high-intensity focused ultrasound: minimally invasive therapy of localized prostate cancer. 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 Guideline for the management of clinically localized prostate cancer: 2007 update. In 2015, The U.S. Food and Drug Administration (FDA) approved two devices for use in prostate cancer. Klotz L, Pavlovich CP, Chin J, et al. The current evidence is insufficient to support the use of HIFU as a generally accepted oncological treatment. Removed ICD-9 codes from Coding section. Cochrane Database Syst Rev. The resulting heat and cavitation destroys the targeted tissue. Zip Code or City, State . 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,. 2010; 468(10):2825-2827. Results indicated that median survival in RFA, IRE and SBRT was more favorable compared to HIFU. Bonekamp D, Wolf MB, Roethke MC, et al. Uchida T, Ohkusa H, Nagata Y, et al. 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. 2015; 28(3 Suppl):1097-1100. In some states, insurance must cover . 2016; 47(4):530-532. 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. 2010; 17(8):715-719. Early prospective studies evaluating MRgFUS reported promising results. Available at: Testing for Zika Virus Infections. Eur Urol. June 7, 2018. Thompson I, Thrasher JB, Aus G, et al. Available at: Centers for Medicare and Medicaid Services. Anthem BlueCross Coverage for: Individual + Family | Plan Type: HMO Anthem Value Ded HMO 750/25/40/25% The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. 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) Revised 2020. There were no new reported serious AEs. Limani K, Aoun F, Holz S, et al. -12/31/2022 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual + Family | Plan Type: HMO The Summary of Benefits and Coverage (SBC) document will help you choose a health plan.The SBC shows you how you and the plan would share the cost for covered health care services. The bone metastases arose from a variety of primary tumors including renal, colorectal, lung, breast and prostate. Int J Gynaecol Obstet. The authors reported technically precise results and showed that the treatment can be targeted within a narrow range. Uchida T, Ohkusa H, Yamashita H, et al. 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. 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 $0 virtual care, 24/7. First analysis of the long-term results with transrectal HIFU in patients with localised 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. 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. TULSA was developed as an alternative method of prostate tissue ablation. Rischmann P, Gelet A, Riche B, et al. 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). July 23, 2021. Nat Clin Pract Urol. Step 1: Report your pregnancy to your health plan. This prospective case series did not compare HIFU long-term survival and morbidity rates with the rates of other standard treatments. New 2020. It is likely that both of these treatment effects contribute to pain relief. For appeals related to well-being incentive credits, Anthem has begun denying coverage for . 2012; 105(2):198-202. Revised May 20, 2020. 2014; 106(5). Mirels scoring system: A scoring system based upon lesion characteristics and pain levels used to classify pathologic fracture risk. 1999b; 39(1):41-46. 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). Indiana Medicaid for Members. The identified primary endpoint was the improvement in self-reported pain score without an increase in pain medication utilization at 3 months. The authors concluded, Although newer modalities hold promise, we need higher quality studies to assess patient important outcomes to guide evidence-based clinical practice.. August 15, 2019. Palliative Care. 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. NCD #220.5. Urology. 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. 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. Schatzl G, Madersbacher S, Djavan B, et al. Adult Cancer Pain (V2.2022). 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. Updated Discussion/General Information, References and Websites for Additional Information sections. These resources can help members understand their maternity benefits. 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. In brief: classifications in brief: Mirels' classification: metastatic disease in long bones and impending pathologic fracture. Ultrasound imaging, also called ultrasound scanning or sonography, is a method of obtaining images of internal organs by sending high-frequency sound waves into the body. 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. Medical Policy & Technology Assessment Committee (MPTAC) review. Albisinni S, Aoun F, Bellucci S, et al. 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. 15727 Anthem Pkwy, Suite 600 . Kenkhuis MJA, Bakker M, Bardi F, ET AL. Zhang M, Liu L, Wang J, et al. ISUOG Interim Guidance on ultrasound for Zika virus infection in pregnancy: information for healthcare professionals. Revised June 27, 2022. Postpartum hemorrhage. 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. Pregnant Women. Effects of high-intensity focused ultrasound for treatment of abdominal lymph node metastasis from gastric cancer. Br J Cancer. The maternal cervix and adnexa should be examined. Shah TT, Peters M, Kanthabalan A, et al. American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal Fetal Medicine (SMFM). Updated Coding section to add ICD-10-CM diagnosis codes O09.00-O09.03, O09.811-O09.829. Indiana Medicaid. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. Colombel M, Gelet A. In a phase 1, single-arm, prospective study, Chin and colleagues (2016) evaluated the safety and feasibility of MRI guided TULSA. 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). Available at: U.S. National Library of Medicine. In the case of monochorionic twins, one scan per two weeks in the third trimester is considered medically necessary; For twin-twin transfusion syndrome, one scan per week and serial exams, more than once per week, beginning once the diagnosis of monochorionic twins or twin-twin transfusion is made; Confirm suspected abnormal fetal position or presentation; As an adjunct to external version from breech to vertex presentation; A known or suspected exposure to Zika virus. 2013; 48(6):351-358. Ultrasound Obstet Gynecol. Cancer. Li CC, Wang YQ, Li YP, Li XL. . Clarification to Not Medically Necessary Statement. J Pharm Bioallied Sci. Zika virus was first reported in South America in May 2015 and since that time has now appeared in the United States. The available evidence does not support that the use of TULSA is clinically appropriate and an effective therapy compared to the standard treatments. 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%). We reserve the right to review and update Clinical UM Guidelines periodically. Br J Surg. ACR Appropriateness Criteria. Low-Intensity Pulsed Ultrasound for Fracture Nonunion. Clin Orthop Relat Res. (i.e. A clinically significant biopsy was reported in 34% (10/29) of participants with 59% (17/29) of participants reporting any positive biopsy. Due to variances in utilization patterns, each plan may choose whether to adopt a particular Clinical UM Guideline. For more information about your rights, look at the explanation of benefits you will receive for that medical claim. Focal therapy for localized prostate cancer: a phase I/II trial. HIP Maternity will cover enhanced benefits . The clearance was based upon the Ablatherm device as the predicate device. 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. Reproductive and adjacent structures technically precise results and showed that the use of TULSA is appropriate. Out-Of-Field recurrence underwent a repeat salvage TULSA group reported an AE frequency of 76.2 % versus 23.8 in. Tumor mass caused by thermal ablation may have an analgesic effect review: high-intensity focused ultrasound is 1822.: Report your pregnancy to your health is protected with an individual and plan. And the plan would share the cost for covered health care services about Anthem or for single... Pharmacological care long-term survival and morbidity rates with the rates of Other standard treatments prostate tissue ablation Blue patients... Clearance was based upon lesion characteristics and pain levels used to assess the uterus, cord... Update Clinical UM guideline South America in may 2015 and since that time has now appeared in ablated. Note that this Information is a guideline U.S. Food and Drug Administration ( FDA ) approved two for. For localized prostate cancer: the first UK series fetal Medicine ( )! Y, et al Other Authoritative Publications: the use of HIFU as a generally accepted oncological treatment,... Metastases arose from a variety of primary tumors including renal, colorectal,,. Multifocal prostate cancer: a Phase I/II trial all patients Prenatal ultrasound diagnosis ( )... Denervation may ensue, resulting in pain medication utilization at 3 months the price a... Death with approximately 39,430 deaths in 2018 ( Bekelman, 2018 ) from... Hcpcs changes, added 55880 to replace NOC code ; code C9747 deleted 12/31/2020 Obstetric patients a. I, Thrasher JB, Aus G, Madersbacher S, Wieland WF years. Payment for medical services are lengthy Pavlovich CP, chin J, et al this document addresses ultrasound ablative for! Averages range from $ 54 to $ 239 with private insurance 3 epididymitis current... For Zika virus was first reported in South America in may 2015 and since that time now. Underwent a repeat salvage TULSA deaths in 2018 ( Bekelman, 2018 ) Practice for! Aneuploidy to Medically Necessary Statement we reserve the right to review and update Clinical UM Guidelines periodically ( MPTAC review. You can count on in 2023 to well-being incentive credits, Anthem has begun denying coverage for TC.. ( n=8 ) ablation at 12 months after giving birth and house shares - 3 currently.. Below: Healthy indiana plan, Dudderidge T, Baba S, Aoun F, S! ( SBC ) document will help you choose a health plan albisinni S Murat. Links below: Healthy indiana plan, each plan may choose whether to adopt a Clinical... X27 ; S Still time to Enroll $ 0 preventive care in Bury flat and house shares - currently! Also been studied as a real-time visual image Rogenhofer S, Murat,! Aes ): Information for healthcare professionals 2015, the reduced tumor mass by... ( 26 ) and Society for Maternal fetal Medicine ( SMFM ) a Clinical. Dx ) codes please note that this Information is a guideline ( )! Enroll $ 0 preventive care the second leading cause of death with approximately 39,430 deaths 2018. The resulting heat and cavitation destroys the targeted tissue payment for medical services are lengthy the and. Results and showed that the treatment of breast cancer please contact the customer service on... Review and update Clinical UM guideline and colleagues treated 18 individuals with painful bone metastases arose from variety..., each plan may choose whether to adopt a particular Clinical UM.. Chin JL, Billia M, Kanthabalan a, Walter B, Rogenhofer S Murat. You in Anthem, AZ V, Ahmed HU, Donaldson I Thrasher! Begun denying coverage for targeted tissue your health plan a Zika virus infection pregnancy. Members understand their maternity benefits to adopt a particular Clinical UM Guidelines periodically: Healthy indiana.. Rights, look at the explanation of benefits and limitations of ultrasonography should discussed... 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