Updated References section. In the absence of specific indications, the optimal time for a single ultrasound examination is at 1822 weeks of gestation. 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, respectively. $15 UK HEALTHCARE PRIMARY CARE CO-PAY $25 ANTHEM PRIMARY CARE CO-PAY $40 Accessed on September 13, 2022. 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 $0 plans in select areas. The new Multiple Delivery policy has the same . To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the member's card. CA/IND/Anthem Silver 73 HMO/657G/01-22 Page 1 of 12 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 73 HMO The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. 2013; 48(6):351-358. After excluding the drop-out groups the results remained similarly statistically significant. Assess vaginal bleeding of undetermined etiology; Assess abdominal or pelvic pain of undetermined etiology; Evaluation of fetal condition in late registrants for prenatal care; History of unexplained fetal demise in a previous pregnancy; Assess the fetus in cases with maternal risk factors such as family history of congenital abnormalities, chronic systemic disease (including but not limited to, hypertension, diabetes or sickle cell disease), preeclampsia, substance abuse or hyperemesis gravidarum; Assessment of fetus after abnormal serum Alpha Fetal Protein (AFP), serum screen or multiple analyte serum screen, or cell-free fetal deoxyribonucleic acid (DNA) screening for aneuploidy; Suspected ectopic pregnancy or hydatidiform mole, and to follow hydatidiform mole; Assess the fetus in cases of Rhesus (Rh) isoimmunization and other causes of fetal hydrops; Provide guidance for other testing, such as amniocentesis, chorionic villus sampling, and cordocentesis or procedures such as intrauterine blood transfusions or other in-utero fetal therapeutic procedures. J Bone Joint Surg Am. Anttinen M, Mkel P, Viitala A, et al. The identified primary endpoint was the improvement in self-reported pain score without an increase in pain medication utilization at 3 months. It is likely that both of these treatment effects contribute to pain relief. 2019; 29(1):299-308. Previously, CDC recommended serial ultrasounds every 3-4 weeks for women with laboratory evidence of Zika virus infection based on existing fetal growth monitoring for other maternal conditions (e.g., hypertension or diabetes). Pain palliation for localized metastatic bone pain. Ultrasound examinations can be used to assess fetal anatomy, particularly neuroanatomy, and to monitor growth. 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. Revised title from High Intensity Focused Ultrasound (HIFU) for Oncologic Indications to Ultrasound Ablation for Oncologic Indications. Ultrasound: A screening or diagnostic technique in which very high frequency sound waves are passed into the body, and the reflected echoes are detected and analyzed to build a picture of the internal organs or of a single fetus or multiple fetuses in the uterus. That coverage comes at a cost, however; specifically, Plan F is the most expensive of all the MedSup policies on the market today. 2000; 14(6):519-528. Gelet A, Chapelon JY, Bouvier R, et al. Medical Encyclopedia. Step 1: Report your pregnancy to your health plan. Assessment of fetal well being, in the absence of the signs, symptoms, or conditions listed above; Providing a keepsake picture of the baby for the parents. In 2021, Nair and colleagues reported the 3-year outcomes of the participants in the Chin study. Br J Cancer. Cancer. Free healthcare job search site: Ultrasound Tech/Sonographer Sonography/Sono job in Tuba City Arizona, USA. The updated file enables providers to separately bill for the professional component (26) and the technical component (TC). In the 25 participants that were able to tolerate a complete treatment, 72% (18/25) reported significant pain reduction of at least 2 points on the VAS scale, 24% (6/25) reported no reduction in pain and 4% (1/25) reported an increase in pain levels. 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). Renal mass and localized renal cancer: Evaluation, management, and follow-up: AUA guideline. The authors reviewed 9 studies with a total of 167 participants. However, the change from baseline in MEDD intake was not statistically significant, although the authors noted a trend towards a statistically significant change. 2021: S1078-1439(21)00173-3. 2008; 38(3):192-199. HAIFA, Israel - MIAMI, Florida (December 22, 2022) Insightec , a global healthcare company dedicated to using acoustic energy to transform patient care, announced today that Anthem is the third national payor to cover MR-guided Focused Ultrasound for treating medication-refractory Essential Tremor. Last Reviewed: August 25, 2022. $0 virtual care, 24/7. The PSA decreased from a median of 6.26 to 0.53 at 12 months. MPTAC review. P110039. 2008; 53(6):1194-1201. Although the exact mechanism of analgesic action of MRgFUS in pain palliation is unknown, studies have pointed to a few explanations. Rebillard X, Gelet A, Davin JL, et al. Taneja SS. Uddin Ahmed H, Cathcart P, Chalasani V, et al. Before you decide to pass on Plan F, though, do your due diligence and see how much the insurance . Ultrasound examinations can be used to assess fetal anatomy, particularly neuroanatomy, and to monitor growth. 2004; 58(4):382-390. The five HIFU trials included a total of only 136 individuals. The available evidence does not support that the use of TULSA is clinically appropriate and an effective therapy compared to the standard treatments. It is completely automated and therefore extremely rigid. TULSA has been proposed as a localized treatment of unilateral intermediate risk prostate cancers in individuals not interested in active surveillance (Klotz, 2021). J Urol. (2018). December 2016. 2004; 7(4):289-294. The 2021 American Urological Association (AUA) published a guideline on renal mases and localized renal cancer. NCD #220.5. Reformatted Coding section. Jpn J Clin Oncol. No ionizing radiation (x-ray) is used in ultrasound imaging. 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 . At 2 weeks follow-up, all individuals experienced a decrease in VAS pain scores from baseline (1.5-5). At 3 months, 72.2% (13/18) reported no pain without the use of pain medication, and 16.7% (3/18) reported a drop of at least 2 points on pain scale without an increase in pain medication. 2015; 102(8):873-882. Updated References and Websites for additional information sections. ACOG Practice Bulletin 163. Available at: Papageorghiou AT, Thilaganathan B, Bilardo CM, et al. 2021; 205(3):769-779. Find job postings in CA, NY, NYC, NJ, TX, FL, MI, OH, IL, PA, GA, MA, WA, UT, CO, AZ, SF Bay Area, LA County, USA, North America / abroad. 2002; 59(3):394-398. Siddiqui KM, Billia M, Arifin A, et al. Initial document development. 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. Uchida T, Sanghvi NT, Gardner TA, et al. Evaluation of quality of life outcomes following palliative treatment of bone metastases with magnetic resonance-guided high intensity focused ultrasound: an international multicentre study. New 2020. There are currently more than 125 Treatment Centers around the world using Insightec's Exablate Neuro platform to treat Essential Tremor. 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. . You can choose your preferred appointment time on our website, www.ultrasound-first.com, or you can call Lexie at the office (314-782-2034) if you need help or have any questions. Treatment of localized prostate cancer using high-intensity focused ultrasound. Rooms for rent in Bury flat and house shares - 3 currently available. The resulting heat and cavitation destroys the targeted tissue. Updated June 13, 2019. In the obese patient, expectations regarding visualization of fetal anatomy should be tempered. AIUM practice guideline for the performance of obstetric ultrasound examinations. July 25, 2018. The doctors in the emergency room did multiple tests including a CT scan and ultrasound. Providers are responsible for billing the appropriate CPT code, modifier, and diagnosis combinations. 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. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Hurwitz MD, Ghanouni P, Kanaev SV, et al. The current evidence is insufficient to support the use of HIFU as a generally accepted oncological treatment. Magnetic resonance imaging-guided transurethral ultrasound ablation of prostate cancer. 2014; 114(4):532-540. Updated Coding section to add ICD-10-CM diagnosis codes O09.00-O09.03, O09.811-O09.829. Radiother Oncol. Hepatogastroenterology. According to the FDA labeling, a nonunion is considered to be established when the fracture site shows no visibly progressive signs of healing. First trimester ultrasound tests alone or in combination with first trimester serum tests for Down's syndrome screening. Ultrasound during pregnancy is used to assess the uterus, umbilical cord and placenta, as well as fetal anatomy and well-being. In November, the FDA approved the use of Ablatherm (Maple Leaf; Toronto, Canada) to treat prostate cancer in individuals who previously failed radiation therapy. 2014; 7(4):270-281. Sonablate was classified as a class II device. One ultrasound of a pregnant uterus per member, per routine course of care; Estimate gestational age for individuals with uncertain clinical dates. To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the member's card. Re: Salvage high-intensity focused ultrasound for patients with recurrent prostate cancer after brachytherapy. American College of Obstetricians and Gynecologists (ACOG). Pregnant Women. 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. 2005; 2(4):191-198. Gelet A, Chapelon JY, Poissonnier L, 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 current standard treatment is external beam radiation therapy (EBRT). 2004; 63(2):297-300. Pain palliation for localized metastatic bone pain Bone pain is a common complaint for individuals with metastatic cancer to the bone. Whole-gland salvage high-intensity focused ultrasound therapy for localized prostate cancer recurrence after external beam radiation therapy. The mean follow-up period was 6.4 years (range, 0.2-13.9). Available at: Limited obstetrical ultrasound examination. Crouzet S, Murat FJ, Pommier P, et al. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. 2001; 15(4):437-440. Ganzer R, Robertson CN, Ward JF, et al. Updated Description, Discussion, References and Websites for Additional Information sections. AIUM Practice Parameter for the Performance of Detailed Second- and Third-Trimester Diagnostic Obstetric Ultrasound Examinations. 2015; 56(2):503-509. Updated Coding section with 10/01/2020 ICD-10-CM changes; added O99.891; removed Q51.20 deleted 09/30/2020. Evaluate for threatened, incomplete, or missed abortion; Non-reassuring fetal heart rate monitoring; Assess amniotic fluid volume in post-term gestation. -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. Klotz L, Pavlovich CP, Chin J, et al. 2009; 16(1):140-146. Nair SM, Hatiboglu G, Relle J, et al. Eur Urol. 2012; 13(6):622-632. Ultrasound is currently being used as a therapeutic treatment, for example, lithotripsy to disintegrate kidney stones. First clinical experience of intra-operative high intensity focused ultrasound in patients with colorectal liver metastases: a phase I-IIa study. Guideline for the management of clinically localized prostate cancer: 2007 update. The American Urological Association (AUA) 2007 guideline on prostate cancer notes that conclusions on the outcomes of HIFU cannot be determined as there is minimal data available on this treatment. * Make sure your health is protected with an Individual and Family plan you can count on in 2023. 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. 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. High intensity focused ultrasound as first line salvage therapy in prostate cancer local relapse after radical prostatectomy: 4-year follow-up outcomes. 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. Available at: Antepartum Fetal surveillance. Transrectal high-intensity focused ultrasound in the treatment of localized prostate cancer: a multicenter study. 2006b; 97(1):56-61. This will stop any POWER account payment or copays while you are pregnant, and for 12 months after giving birth. Urology. 2000; 37(6):695-701. Bone metastasesWhen services may be Medically Necessary when criteria are met: Unlisted procedure, musculoskeletal system, general [when specified as high intensity focused ultrasound ablation for pain palliation for bone metastases], Focused ultrasound ablation/therapeutic intervention, other than uterine leiomyomata, with magnetic resonance (MR) guidance. Known or suspected abnormality of placenta: Assess placental location associated with vaginal bleeding; Suspected abnormal placental attachment (placenta accreta); Suspected retained placenta or products of conception. High-intensity focused ultrasound (HIFU) followed after one to two weeks by radical retropubic prostatectomy: results of a prospective study. Ahmed HU, Zacharakis E, Dudderidge T, et al. Hemi salvage high-intensity focused ultrasound (HIFU) in unilateral radiorecurrent prostate cancer: a prospective two-centre study. Anthem Blue Cross and Blue Shield - BlueAdvantage POS Colorado Higher Education Insurance Benefits Alliance Trust Coverage for: Individual + Family | Plan Type: HMO . Prostate cancer is the second leading cause of death with approximately 39,430 deaths in 2018 (Bekelman, 2018). Blana A, Murat FJ, Walter B, et al. ACR-ACOG-AIUM-SMFM-SRU Practice parameter for the performance of obstetrical ultrasound. MedlinePlus. Real-time magnetic resonance-guided high-intensity focused ultrasound focal therapy for localised prostate cancer: preliminary experience. *Coverage includes fertility preservation . We are now accepting all Anthem Blue Cross Blue Shield patients. Following treatment, no residual tumor was found in 46.2% of cases. August 27, 2020. Low-Intensity Pulsed Ultrasound for Fracture Nonunion. Br J Surg. Available at: ACOG. Ahmed HU, Cathcart P, McCartan N, et al. The authors noted these results compared well to the radiation therapy complication rate. Our radiologists are among the most . Find a doctor near you. Clin Oncol (R Coll Radiol). A statistically significant pain response was reported in 70.7% of this group. Grade 3 (n=1) and grade 2 (n=3) AEs related to urinary retention and urinary tract infection were reported. grievance or appeal. Available at: U.S. National Library of Medicine. No. The SBC shows you how you and the plan would share the cost for covered health care services. 2015; 194(1):114. 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). HIP Maternity will cover enhanced benefits . Kenkhuis MJA, Bakker M, Bardi F, ET AL. Pregnant Women. The SBC shows you how you and the 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. HIFU treatment is combined with a visualization method, frequently MR guidance, to better guide treatment in real time. 2005; 4(3):187-192. MPTAC review. Safety trial of high-intensity focused ultrasound therapy for pancreatic cancer. 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. J Ultrasound Med. Available at: Dahm P, Brasure M, Ester E, et al. NOTE: Information about the cost of this plan (called the . June 2021. In some states, insurance must cover . 2018; 30(4):233-242. J Evid Based Med. Available at: Second and Third Trimester Vaginal Bleeding. National Coverage Determination: Ultrasound diagnostic procedures. Effects of high-intensity focused ultrasound for treatment of abdominal lymph node metastasis from gastric cancer. 15727 Anthem Pkwy, Suite 600 . Reviewed and validity confirmed 2011. Search doctors, conditions, or procedures . Approved August 19, 2021. Elterman D, Li W, Hatiboglu G, et al. Updated Coding, Description, Discussion/General Information, and References. This study was a retrospective case series involving 804 subjects who underwent HIFU and were included in an industry-sponsored registry. Update date: March 4, 2022. In an intent-to-treat analysis, 63% (72/115) were reported to have a complete histological response and had no evidence of cancer. HIFU has been proposed as a treatment for multiple oncologic conditions. Moved content of MED.00119 High Intensity Focused Ultrasound (HIFU) for Oncologic Indications to new clinical utilization management guideline document with the same title. A total of 29 individuals underwent a follow-up biopsy, either at 12 months only, or at 12 and 36 months. Available at: Centers for Disease Control and Prevention (CDC). 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. 1999b; 39(1):41-46. Updated Coding section with 10/01/2016 ICD-10-CM diagnosis code changes. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. 2015 Mar;34(3):435-440. The SBC shows you how you and the plan would share the cost for covered health care services. Magnetic resonance imaging-guided transurethral ultrasound ablation in patients with localised prostate cancer: 3-year outcomes of a prospective Phase I study. 2013; 63(2):395-398. Summary of Safety and Effectiveness Data (SSED). Anthem isn't the only insurer trying to find a way around hospitals' steeper costs for outpatient imaging, says Lea Halim, a senior consultant at the Advisory Board, a health care research and. American College of Radiology (ACR). Chaussy C, Thuroff S. The status of high-intensity focused ultrasound in the treatment of localized prostate cancer and the impact of a combined resection. NCCN Clinical Practice Guidelines in Oncology. Cochrane Database Syst Rev. 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. The document header wording updated from Current Effective Date to Publish Date. Updated Discussion/General Information, References and Websites for Additional Information sections. J Pharm Bioallied Sci. Shoji S, Nakano M, Nagata Y, et al. You bet! 2014; 65(5):907-914. Updated References. The recommendations are based on limited data. Pain palliation in patients with bone metastases using MR-guided focused ultrasound surgery: a multicenter study. . Cochrane Database Syst Rev. Principles and results of high-intensity focused ultrasound for localized prostate cancer. * From Jawad MU, Scully SP. American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal Fetal Medicine (SMFM). Harding D, Giles SL, Brown MRD, et al. 2015; 2015(7):CD007058. Bone metastasis: When cancer cells have broken off from the primary tumor and have settled and started growing on bones. In addition to treatment, these individuals should undergo a sonographic fetal evaluation to evaluate for signs of fetal or placental syphilis. 2021; 127(5):544-552. Added not medically necessary statement for TULSA. High-intensity focused ultrasound for the treatment of localized prostate cancer: 5-year experience. HIFU or MRgFUS has also been studied as a potential treatment of various cancers. HIFU is a non-invasive ablative procedure which has the advantage of sparing surrounding tissue which may reduce postoperative morbidity and hasten recovery. When services are Not Medically Necessary:For the procedure and diagnosis codes listed above when criteria are not met. Li CC, Wang YQ, Li YP, Li XL. 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. Approved May 19, 2020. Lancet Oncol. J Natl Cancer Inst. Focal therapies are proposed as less invasive treatment options when compared to radical prostatectomy or radiation therapy. 2018; 74(4):422-429. August 15, 2019. Napoli A, Anzidei M, De Nunzio C, et al. 2017. Eur Urol. Mol Urol. Ultrasound imaging can be used after delivery to evaluate abnormalities of the reproductive and adjacent structures. J Urol. Therapies for clinically localized prostate cancer [Internet]. Thuroff S, Chaussy C. High-intensity focused ultrasound: complications and adverse events. 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. Review January 10, 2022. 2015; 10(2):e0118212. We reserve the right to review and update Clinical UM Guidelines periodically. Focal salvage high-intensity focused ultrasound in radiorecurrent prostate cancer. Focal therapy for localised unifocal and multifocal prostate cancer: a prospective development study. 2017; 120(2):246-256. MPTAC review. Crouzet S, Blana A, Murat FJ, et al. 2017; 3:CD012600. Ahmed HU, Freeman A, Kirkham A, et al. Management of prostate-specific antigen relapse in prostate cancer: a European Consensus. Prostate Cancer Prostatic Dis. Available at: U.S. National Library of Medicine. 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. Prostate Cancer (V1.2023). 2011; 3(3):329-338. Prostate Cancer. Committee Opinion 723. A multicentre study of 5-year outcomes following focal therapy in treating clinically significant nonmetastatic prostate cancer. The mean reduction in the NRS score was significant between MRgFUS and placebo (3.6 3.1 versus 0.7 2.4). When an embryo/fetus is detected, it should be measured, and the cardiac activity should be recorded by 2-D video clip or M-mode. The value of adding a universal booking scan to an existing protocol of routine mid-gestation ultrasound scan. BJU Int. Prostate Cancer. First analysis of the long-term results with transrectal HIFU in patients with localised prostate cancer. close combat footage enemy visible bungee fitness dickson tn Tue, Oct 18 2022 Government Agency, Medical Society, and Other Authoritative Publications: Maternal UltrasoundObstetricPrenatalSonography. In 2015, The U.S. Food and Drug Administration (FDA) approved two devices for use in prostate cancer. Liberman and associates (2009) used MRgFUS to treat 31 individuals with painful bone metastases who had exhausted or refused all other pain palliation methods. Updated Coding section with 10/01/2018 ICD-10-CM diagnosis code changes; added Q51.20-Q51.28, Z20.821. Technology insight: High-intensity focused ultrasound for urologic cancers. Anttinen and associates (2020) evaluated TULSA use as a partial salvage therapy in individuals with localized, recurrent prostate cancer. 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. Breast MRI costs an average $615 under Medicare . 2010; 468(10):2825-2827. September 15, 2017. 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.