anthem ultrasound coverage

Shi Y, Ying X, Hu X, et al. Int J Gynaecol Obstet. In the absence of specific indications, the optimal time for a single ultrasound examination is at 1822 weeks of gestation. check_circle Item Saved! 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. For more information about your rights, look at the explanation of benefits you will receive for that medical claim. J Ultrasound Med. 2014; 2014:186782. Ganzer R, Robertson CN, Ward JF, et al. Surgery: MRgFUS-non invasive treatment for patients with painful bone metastasis. National Coverage Determination: Ultrasound diagnostic procedures. You should contact Anthem Blue Cross and Blue Shield directly to appeal denial of coverage for medical claims by calling 1855- -641-4862. The updated file enables providers to separately bill for the professional component (26) and the technical component (TC). 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. 2017. Rockville (MD): Agency for Healthcare Research and Quality (US); 2020 Sep. Report No. . Reviewed and validity confirmed 2011. 2014; 20(28):9570-9577. Prostate Cancer Prostatic Dis. Therapies for clinically localized prostate cancer [Internet]. The wait is over. Dupr A, Melodelima D, Prol D, et al. 2017; 69(1):93-100. Eur Urology. Blana A, Murat FJ, Walter B, et al. CA/LG/Anthem PPO HSA/H 2000/3000/4000 20/40/73A3/01-23 Page 1 of 11 Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Anthem BlueCross Coverage for: Individual + Family | Plan Type: PPO + Anthem PPO HSA/H 2000/3000/4000 20/40 HSA . 2005; 4(3):187-192. AIUM Practice Parameter for the Performance of Detailed Second- and Third-Trimester Diagnostic Obstetric Ultrasound Examinations. 2017; 119(6):896-904. 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). 2009; 16(1):140-146. Addition of cell-free fetal deoxyribonucleic acid (DNA) screening for aneuploidy to Medically Necessary Statement. 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. Added not medically necessary statement for TULSA. There were 12 grade 3 adverse events (AEs) attributable to the TULSA-PRO, all of which were resolved by 12 months. Palliative treatment: Treatment given for relief of symptoms and pain rather than attempting to cure. Cancer. These Medical Policies serve as guidelines for health care benefit coverage decisions, which may vary according to the different products and benefit plans offered by BCBSIL. This document addresses the use of maternity ultrasound in the outpatient setting. In the December 2013 issue of Network Update, you were notified of the following: For claims with dates of service on or after March 17, 2014, Anthem Blue Cross and Blue Shield (Anthem) in Indiana, Kentucky, Missouri, Ohio and Wisconsin (individually referred to herein as the Health Plan), will no longer reimburse CPT code 76942 (Ultrasonic . Low-Intensity Pulsed Ultrasound for Fracture Nonunion. 2015; 102(3):182-193. Int J Clin Pract. Updated Coding section with 10/01/2018 ICD-10-CM diagnosis code changes; added Q51.20-Q51.28, Z20.821. A statistically significant pain response was reported in 70.7% of this group. 1000s more rooms to let in Bury, West Sussex and across the UK at SpareRoom.co.uk - the UK's #1 flatshare site. 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. 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. 2015; 62(137):140-143. 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. 2014; 11(6):303. The current evidence is insufficient to support the use of HIFU as a generally accepted oncological treatment. J Urol. The use of high intensity focused ultrasound (HIFU) is considered medically necessary for pain palliation in individuals with localized metastatic bone pain when all the following criteria are met: High intensity focused ultrasound (HIFU) is considered not medically necessary when the above criteria are not met and for all other indications, including but not limited to, the treatment of prostate cancer. It is completely automated and therefore extremely rigid. August 15, 2019. ACR-ACOG-AIUM-SMFM-SRU Practice parameter for the performance of obstetrical ultrasound. Curr Urol Rep. 2003; 4(3):248-252. Moved content of MED.00119 High Intensity Focused Ultrasound (HIFU) for Oncologic Indications to new clinical utilization management guideline document with the same title. Crouzet S, Blana A, Murat FJ, et al. grievance or appeal. This document addresses ultrasound ablative therapy for the treatment of oncologic conditions. There are concerns about inconsistent treatment coverage within renal masses resulting in incomplete ablation. These resources can help members understand their maternity benefits. Rooms for rent in Bury flat and house shares - 3 currently available. For appeals related to well-being incentive credits, Approved August 19, 2021. We reserve the right to review and update Clinical UM Guidelines periodically. Crouzet S, Murat FJ, Pommier P, et al. Crouzet S, Chapelon JY, Rouvire O, et al. Uddin Ahmed H, Cathcart P, Chalasani V, et al. 2021; 35(4):497-505. Twelve-month prostate volume reduction after MRI-guided transurethral ultrasound ablation of the prostate. 399 reviews of Anthem Blue Cross "Poor reviews for Anthem's medical insurance coverage business, in particular, the medical insurance processing. Uchida T, Ohkusa H, Nagata Y, et al. 2015; 193(1):103-110. $0 virtual care, 24/7. The doctors in the emergency room did multiple tests including a CT scan and ultrasound. Salvage high-intensity focused ultrasound (HIFU) for locally recurrent prostate cancer after failed radiation therapy: Multi-institutional analysis of 418 patients. The Centers for Medicare and Medicaid Services (CMS) released an updated Relative Value file Jan. 5, that includes updated reimbursement for the neuromuscular ultrasound codes 76881, 76882 and 76883. However, EBRT has been shown to be ineffective in approximately 20-30% of cases and pain recurs in 27% of the treated population (Liberman, 2009). 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). Early prospective studies evaluating MRgFUS reported promising results. Quality of life following high-intensity focused ultrasound for the treatment of localized prostate cancer: a prospective study. The study also included a crossover component; 17 of the 23 individuals in the placebo group who did not complete follow-up chose to receive rescue MRgFUS after a lack of response to placebo. Thuroff S, Chaussy C, Vallancien G, et al. Available at: Second and Third Trimester Vaginal Bleeding. Government Agency, Medical Society, and Other Authoritative Publications: The use of specific product names is illustrative only. ACOG Practice Bulletin Number 229. Rombouts SJ, Vogel JA, van Santvoort HC, et al. Prenatal ultrasound-series. 1999a; 54(2):273-277. Eur Urol. 2014; 65(5):907-914. Nair SM, Hatiboglu G, Relle J, et al. When services are Not Medically Necessary:For the procedure and diagnosis codes listed above when criteria are not met or for all other diagnoses not listed; or when the code describes a procedure or situation designated in the Clinical Indications section as not medically necessary. Find top doctors who perform Rectal Ultrasound near you in Anthem, AZ. Accessed on October 20, 2022. Pregnant Women. See the following related document for HIFU treatment non-oncologic indications: For information regarding other palliative treatments of metastatic bone lesions, please see the following: Metastatic lesions located 1 centimeter (cm) or greater from skin and major nerve bundles; Individual does not present an increased risk of fracture from the procedure (for example, a score of 7 or less on Mirels fracture risk score); Individual does not require surgical stabilization or have clinically significant comorbidities; Individual is not a candidate for other therapies as evidenced by pain refractory to previous radiation therapy. The feasibility and safety of high-intensity focused ultrasound as salvage therapy for recurrent prostate cancer following external beam radiotherapy. Available at: Magnetic Resonance guided Focused Ultrasound Surgery System (MRgFUS) ExAblate Model 2000/2100. MPTAC review. Number 7. Summary of Safety and Effectiveness Data (SSED). 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. 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. Clin Oncol (R Coll Radiol). November 6, 2015. 2019; 29(1):299-308. Bone metastasis: When cancer cells have broken off from the primary tumor and have settled and started growing on bones. 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 . Ahmed HU, Cathcart P, McCartan N, et al. Updated: June 16, 2022. Chin JL, Billia M, Relle J, et al. Find a doctor near you. J Urol. close combat footage enemy visible bungee fitness dickson tn Tue, Oct 18 2022 2001; 15(4):437-440. While some trials using HIFU to treat pancreatic or liver cancer have shown some promising results, these trials have lacked a comparator group (Chen, 2015; Dupr, 2015; Shi, 2015; Sofuni, 2014). J Ther Ultrasound. Contact us today for information about Anthem or for questions regarding Medicaid programs and coverage. In 2013, Napoli and colleagues treated 18 individuals with painful bone metastases with MRgFUS. Eligibility included those at least 18 years old with at least a 3-month life expectancy with bone metastases which were painful despite previous radiation therapy (RT) but unsuitable for further RT. 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. 2015; 10(2):e0118212. Comprehensive medical coverage that covers many common services at no cost or for a low copay. The mean follow-up period was 6.4 years (range, 0.2-13.9). FAQ 133, July 2021. J Bone Joint Surg Am. Clin Orthop Relat Res. 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. In the obese patient, expectations regarding visualization of fetal anatomy should be tempered. HIFU or MRgFUS has also been studied as a potential treatment of various cancers. Prostate cancer is the second leading cause of death with approximately 39,430 deaths in 2018 (Bekelman, 2018). Int J Urol. 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. Reformatted Coding section. Adverse events included grade 1 or 2 hematuria, urinary tract infections or acute urinary retention, and grade 3 epididymitis. This study was defined by the regulatory agency to evaluate the effectiveness of the device to ablate prostate tissue. . U.S. Food and Drug Administration (FDA). A clinically significant biopsy was reported in 34% (10/29) of participants with 59% (17/29) of participants reporting any positive biopsy. The authors theorized that the high rate of salvage treatment at 3 years follow-up could be attributed to suboptimal staging and treatment. Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline. Available at: American Institute of Ultrasound in Medicine (AIUM). First trimester ultrasound tests alone or in combination with first trimester serum tests for Down's syndrome screening. Mirels scoring system: A scoring system based upon lesion characteristics and pain levels used to classify pathologic fracture risk. World J Gastroenterol. Anthem Blue Cross Blue Shield: Health Insurance, Medicare & More Learn more about your coverage options after the Public Health Emergency (PHE) ends. Available at: Limited obstetrical ultrasound examination. The authors noted these results compared well to the radiation therapy complication rate. Accessed on September 13, 2022. Jawad MU, Scully SP. A total of 22 individuals participated in the follow-up. MPTAC review. As the bone cortex absorbs high ultrasound energy, periosteal denervation may ensue, resulting in pain relief. Kaur A, Kaur A. Transvaginal ultrasonography in first trimester of pregnancy and its comparison with transabdominal ultrasonography. Adult Cancer Pain (V2.2022). Updated References section. The recommendations are based on limited data. Updated Coding section with additional diagnosis codes D25.0-D25.9, O26.872-O26.879, O99.210-O99.213, O99.810. Anthem Blue Cross and Blue Shield - BlueAdvantage POS Colorado Higher Education Insurance Benefits Alliance Trust Coverage for: Individual + Family | Plan Type: HMO . 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. Revised June 27, 2022. American Urological Association (AUA). 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. Ann Surg Oncol. One of the largest of these studies was conducted by Ganzer and colleagues (2011). Ahmed HU, Freeman A, Kirkham A, et al. Replaced term women with individual within clinical indications. These studies have a number of methodological limitations, including a lack of randomization of participants, a lack of a comparator group and limited follow-up for oncologic outcomes. Updated Description, Coding, Discussion and References sections. Thompson I, Thrasher JB, Aus G, et al. Anthem has begun denying coverage for . 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). 2006b; 97(1):56-61. 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 . The Summary of Benefits and Coverage (SBC) document will help you choose a health plan.
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