anthem ultrasound coverage

Government Agency, Medical Society, and Other Authoritative Publications: The use of specific product names is illustrative only. Added medically necessary indication when there is a known or suspected exposure to the Zika virus to the Clinical Indications section. 2015; 102(3):182-193. The 2021 American Urological Association (AUA) published a guideline on renal mases and localized renal cancer. Eur Urol. . The authors noted these results compared well to the radiation therapy complication rate. -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. To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the member's card. Reapproved June 16, 2020. Updated Coding section to add ICD-10-CM diagnosis codes O09.00-O09.03, O09.811-O09.829. 2016; 47(4):530-532. Kaur A, Kaur A. Transvaginal ultrasonography in first trimester of pregnancy and its comparison with transabdominal ultrasonography. 2012; 118(12):3071-3078. 2008; 53(6):1194-1201. 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. HIFU therapy was included in a comparative effectiveness review of clinically localized prostate cancer treatments (Dahm, 2020). close combat footage enemy visible bungee fitness dickson tn Tue, Oct 18 2022 Two-year results of transurethral resection of the prostate versus four 'less invasive' treatment options. Int J Gynaecol Obstet. Pain palliation for localized metastatic bone pain Bone pain is a common complaint for individuals with metastatic cancer to the bone. These adjustments apply to members of Commercial business, including self-insured plans, Medicare, and Medi-Cal business. The authors concluded, Although newer modalities hold promise, we need higher quality studies to assess patient important outcomes to guide evidence-based clinical practice.. No. The current evidence does not show that clinical outcomes of those undergoing TULSA is similar to those undergoing established alternatives. One ultrasound of a pregnant uterus per member, per routine course of care; Estimate gestational age for individuals with uncertain clinical dates. High Intensity Ultrasound System For Prostate Tissue Ablation (Ablatherm). MPTAC review. High intensity focused ultrasound (HIFU): A surgical procedure that uses focused high energy sound waves to destroy target tissues in the body. 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. 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. Ultrasound Obstet Gynecol. 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. That coverage comes at a cost, however; specifically, Plan F is the most expensive of all the MedSup policies on the market today. In those individuals who reported a decrease in pain levels, 50% (9/18) reported complete relief of pain, with 52% reporting significant pain relief beginning 3 days post treatment. The treatment group reported an AE frequency of 76.2% versus 23.8% in the sham group. 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. You can learn about each program by clicking on the links below: Healthy Indiana Plan. MPTAC review. American College of Obstetricians and Gynecologists (ACOG). HIFU has been evaluated as a minimally invasive treatment of whole gland or a focal treatment of prostate cancer, both in the initial treatment of clinically localized prostate cancer and following recurrence. The document header wording updated from Current Effective Date to Publish Date. Updated Discussion/General Information, References and Websites for Additional Information sections. Salvage high-intensity focused ultrasound for patients with recurrent prostate cancer after brachytherapy. For appeals related to well-being incentive credits, Transurethral ultrasound ablation (TULSA), which delivers directional thermal ultrasound via a catheter inserted into the urethra, is specific to prostate cancer. Crouzet S, Chapelon JY, Rouvire O, et al. Ahhhhh! This document addresses the use of maternity ultrasound in the outpatient setting. 2014; 11(6):303. Harding D, Giles SL, Brown MRD, et al. Revised June 27, 2022. There was 1 in-field and 2 out-of-field recurrences reported at that time. Int J Urol. Available at: American Institute of Ultrasound in Medicine (AIUM). 2017; 120(2):246-256. (i.e. 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 2005; 19(6):693-701. Available at: Centers for Disease Control and Prevention (CDC): How is Prostate Cancer Treated? Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline. 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). American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal Fetal Medicine (SMFM). Systematic review of innovative ablative therapies for the treatment of locally advanced pancreatic cancer. Known or suspected abnormality of maternal reproductive structure: Clinical suspicion of cervical insufficiency (for example, abnormal cervix on physical examination, maternal history of second trimester pregnancy loss, prior cervical surgery, and diethylstilbestrol [DES] exposure); To assess cervical length in the second or third trimester in individuals with a history of one or more pregnancy losses in the second or early third trimester or in individuals who have had preterm labor in the current pregnancy or in multi-fetal pregnancies; Provide guidance for cervical cerclage placement; Confirm suspected anatomical uterine abnormality, including fibroid uterus; Localization of intrauterine device (IUD); Evaluate a pelvic mass that has been detected clinically. Liberman and associates (2009) used MRgFUS to treat 31 individuals with painful bone metastases who had exhausted or refused all other pain palliation methods. J Urol. Sofuni A, Moriyasu F, Sano T, et al. List Your Practice ; Search . 2021: S1078-1439(21)00173-3. 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. 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. First clinical experience of intra-operative high intensity focused ultrasound in patients with colorectal liver metastases: a phase I-IIa study. MPTAC review. J Endourol. BJU Int. Evaluation of quality of life outcomes following palliative treatment of bone metastases with magnetic resonance-guided high intensity focused ultrasound: an international multicentre study. According to the FDA labeling, a nonunion is considered to be established when the fracture site shows no visibly progressive signs of healing. 2000; 14(6):519-528. $0 plans in select areas. Muto S, Yoshii T, Saito K, et al. Ultrasound during pregnancy is used to assess the uterus, umbilical cord and placenta, as well as fetal anatomy and well-being. Principles and results of high-intensity focused ultrasound for localized prostate cancer. Clin Genitourin Cancer. MPTAC review. You should contact Anthem Blue Cross and Blue Shield directly to appeal denial of coverage for medical claims by calling 1855- -641-4862. 2004; 63(4):625-629. Cancer. Updated Coding section with 10/01/2016 ICD-10-CM diagnosis code changes. Focal therapy for localized prostate cancer: a phase I/II trial. Transrectal high-intensity focused ultrasound using the Ablatherm device in the treatment of localized prostate carcinoma. Indiana Medicaid. J Ther Ultrasound. 2013; 63(2):395-398. World J Gastroenterol. Birth Defects Homepage: Diagnosis. Bonekamp and associates (2019) performed a quantitative analysis of viable prostate tissue volume reduction at 12 months post-procedure. October 2016. Lumiani A, Samun D, Sroka R, Muschter R. Single center retrospective analysis of fifty-two prostate cancer patients with customized MR-guided transurethral ultrasound ablation (TULSA). Reformatted Coding section. Summary of Safety and Effectiveness Data (SSED). Radiother Oncol. It is likely that both of these treatment effects contribute to pain relief. Rockville (MD): Agency for Healthcare Research and Quality (US); 2020 Sep. Report No. Uchida T, Ohkusa H, Yamashita H, et al. The uterus, cervix, adnexa, and cul-de-sac region should be examined. Jawad MU, Scully SP. 2014; 65(5):907-914. ; AUA Prostate Cancer Clinical Guideline Update Panel. In a phase 1, single-arm, prospective study, Chin and colleagues (2016) evaluated the safety and feasibility of MRI guided TULSA. Rischmann P, Gelet A, Riche B, et al. Available at: Antepartum Fetal surveillance. Albisinni S, Aoun F, Bellucci S, et al. Bertrand AS, Iannessi A, Natale R, et al. Insurance coverage for whole-breast ultrasound is evolving. Comprehensive medical coverage that covers many common services at no cost or for a low copay. 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. There were no treatment-related AEs. Medicare Supplement Plan F is great because it provides the most coverage of the 10 currently available MedSup plans. There is insufficient evidence to draw conclusions about the effect of HIFU on urinary incontinence, erectile dysfunction or fecal incontinence when compared to radical prostatectomy. Low-Intensity Pulsed Ultrasound for Fracture Nonunion. PSA nadir as a predictive factor for biochemical disease-free survival and overall survival following whole-gland salvage HIFU following radiotherapy failure. 2018; 30(4):233-242. Zika Virus. Anthem has begun denying coverage for . Prostate cancer is the most commonly diagnosed cancer in men, accounting for 19% of all new cancer cases. 2004; 7(4):289-294. In an intent-to-treat analysis, 63% (72/115) were reported to have a complete histological response and had no evidence of cancer. BJU Int. Accessed on September 13, 2022. We reserve the right to review and update Clinical UM Guidelines periodically. Kanthabalan A, Peters M, Van Vulpen M, et al. Adverse events included grade 1 or 2 hematuria, urinary tract infections or acute urinary retention, and grade 3 epididymitis. 2021. The maternal cervix and adnexa should be examined. The mean follow-up period was 6.4 years (range, 0.2-13.9). 2013; 48(6):351-358. J Urol. December 2016. 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. Ultrasound examinations can be used to assess fetal anatomy, particularly neuroanatomy, and to monitor growth. BJU Int. Participants included those who could not undergo or refused all other available options for pain palliation. 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. Available at: Second and third trimester screening for fetal anomaly. The authors reported that salvage TULSA was technically feasible and showed encouraging early results but have not been compared to standard therapy. After excluding the drop-out groups the results remained similarly statistically significant. 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. Yutkin V, Ahmed HU, Donaldson I, et al. CPT codes Dx codes 76801 76802 D25, D25.0, D25.1, D25.2, D25.9, O0900, O0901, O0902, O0903, O09511, O09512, Updated References. Federal and State law, as well as contract language, and Medical Policy take precedence over Clinical UM Guidelines. 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. Dupr A, Melodelima D, Prol D, et al. 2003; 17(8):673-677. Updated Coding section; added ICD-10-CM code ranges O98.111-O98.119, O99.310-O99.313, O99.320-O99.323, O99.330-O99.333. Br J Surg. The wait is over. 2009; 101(1):19-26. Clin Orthop Relat Res. Review January 10, 2022. Focal salvage therapy for localized prostate cancer recurrence after external beam radiotherapy: a pilot study. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. The bone metastases arose from a variety of primary tumors including renal, colorectal, lung, breast and prostate. The doctors in the emergency room did multiple tests including a CT scan and ultrasound. Zacharakis E, Ahmed HU, Ishaq A, et al. Boccon-Gibod L, Djavan WB, Hammerer P, et al. Colombel M, Gelet A. The focus of this study was the use of prostate specific antigen (PSA) as a predictor of disease-free survival after HIFU, not the outcomes related to HIFU treatment. This guideline was reviewed and validated in 2011. Peek and associates (2015) conducted a systematic review of the use of HIFU in breast cancer. Ultrasound is currently being used as a therapeutic treatment, for example, lithotripsy to disintegrate kidney stones. Nair SM, Hatiboglu G, Relle J, et al. 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. Updated June 13, 2019. While the analysis showed superior survival rates at 6 and 12 months in the groups which included HIFU in combination therapy, the authors noted that the overall quality of the studies was poor. 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%). Gardner TA, Koch MO. The 2018 ACR/AIUM/ACOG/SMFM/SRU practice parameter notes Obstetrical ultrasound should be performed only when there is a valid medical reason, and the lowest possible ultrasonic exposure settings should be used to gain the necessary diagnostic information.. Prostate Cancer Prostatic Dis. First trimester ultrasound tests alone or in combination with first trimester serum tests for Down's syndrome screening. 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). ACOG Practice Bulletin Number 171. Ultrasound in pregnancy. Indiana Medicaid for Members. Updated Discussion, References and Websites for Additional Information sections. . J Ultrasound Med 2013; 32(6):1083-1101. AIUM Practice Parameter for the Performance of Limited Obstetric Ultrasound Examinations by Advanced Clinical Providers. MedlinePlus. The clearance was based upon the Ablatherm device as the predicate device. Twelve-month prostate volume reduction after MRI-guided transurethral ultrasound ablation of the prostate. In 2012, the FDA approved via the Premarket Application (PMA) process, the ExAblate System (InSightec, Ltd, Dallas, TX) for pain palliation in individuals 18 years and older who have metastatic bone cancer pain and have failed, are not candidates for or have refused standard radiation therapy. 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. Hepatogastroenterology. July 25, 2018. TULSA has been proposed as a localized treatment of unilateral intermediate risk prostate cancers in individuals not interested in active surveillance (Klotz, 2021). Anttinen M, Mkel P, Viitala A, et al. Approximately 30% of all individuals with cancer develop metastatic bone lesions and 50-75% of these individuals report significant pain. Thuroff S, Chaussy C, Vallancien G, et al. Please enter a valid 5-digit Zip Code. High-intensity focused ultrasound in the treatment of primary prostate cancer: the first UK series. Hemi salvage high-intensity focused ultrasound (HIFU) in unilateral radiorecurrent prostate cancer: a prospective two-centre study. Visit our official site today for more details. 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. Updated September 20, 2021. Beerlage HP, Thuroff S, Debruyne FM, et al. No ionizing radiation (x-ray) is used in ultrasound imaging. Local recurrence of prostate cancer after external beam radiotherapy: early experience of salvage therapy using high-intensity focused ultrasonography. At 12 months, the majority of participants (10/11) were cancer free in the ablated area and maintained a low stable PSA. Committee Opinion 723. Pathological, oncologic and functional outcomes of a prospective registry of salvage high intensity focused ultrasound ablation for radiorecurrent prostate cancer. Transrectal high-intensity focused ultrasound in the treatment of localized prostate cancer: a multicenter study. Quality of life following high-intensity focused ultrasound for the treatment of localized prostate cancer: a prospective study. Added not medically necessary statement for TULSA. Lancet Oncol. For other common visits, this is what you'll pay with PPO. By March 2018, Anthem (Blue Cross/Blue Shield) will require that MR and CT scans considered "not medically necessary" be performed at freestanding medical imaging facilities in order to be covered. Previously, this recommendation was graded as a 2A. Sonablate was classified as a class II device. 2015; 56(2):503-509. Magnetic resonance imaging-guided transurethral ultrasound ablation in patients with localised prostate cancer: 3-year outcomes of a prospective Phase I study. 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. 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. Bonekamp D, Wolf MB, Roethke MC, et al. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Bone metastasis: When cancer cells have broken off from the primary tumor and have settled and started growing on bones. Federal and State law, as well as contract language, and Medical Policy take precedence over Clinical UM Guidelines. 2015; 2015(7):CD007058. Early prospective studies evaluating MRgFUS reported promising results. Prostate Cancer Prostatic Dis. Therapies for clinically localized prostate cancer [Internet]. In addition to treatment, these individuals should undergo a sonographic fetal evaluation to evaluate for signs of fetal or placental syphilis. Subtle second-trimester ultrasound markers should be interpreted in the context of a background risk based on the patients age, history, genetic screening, and serum screening results. 2011; 3(3):329-338. 2019; 29(1):299-308. August 27, 2020. Alternatively, the reduced tumor mass caused by thermal ablation may have an analgesic effect. 2007; 51(2):381-387. Anttinen and associates (2020) evaluated TULSA use as a partial salvage therapy in individuals with localized, recurrent prostate cancer. Prostate cancer therapy with high-intensity focused ultrasound. HIP Maternity will cover enhanced benefits . 2015; 2015(6):CD001451. 2005; 51(10):651-658. This document does not address nuchal translucency. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise, without permission from the health plan. High-intensity focused ultrasound and localized prostate cancer: efficacy results from the European multicentric study. Clin Orthop Relat Res. MPTAC review. 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. The prospective, nonrandomized, investigator-initiated, single-arm, single-center phase 1 study included 11 individuals with localized, histopathologically verified, radio-recurrent prostate cancer. 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. 2014; 7(4):270-281. Thuroff S, Chaussy C. High-intensity focused ultrasound: complications and adverse events. Last Revised March 16, 2022. Nat Rev Clin Oncol. Bricker L, Medley N, Pratt JJ. 2021; 35(4):497-505. 2006b; 97(1):56-61. American College of Radiology (ACR). At 2 weeks follow-up, all individuals experienced a decrease in VAS pain scores from baseline (1.5-5). 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 Although the exact mechanism of analgesic action of MRgFUS in pain palliation is unknown, studies have pointed to a few explanations. MedlinePlus. Management of prostate-specific antigen relapse in prostate cancer: a European Consensus. Curr Urol Rep. 2003; 4(3):248-252. 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. 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). Available at: Magnetic Resonance guided Focused Ultrasound Surgery System (MRgFUS) ExAblate Model 2000/2100. Urology. (2018). Adult Cancer Pain (V2.2022). * From Jawad MU, Scully SP. A clinically significant biopsy was reported in 34% (10/29) of participants with 59% (17/29) of participants reporting any positive biopsy. Uchida T, Sanghvi NT, Gardner TA, et al. 510K Premarket notification. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Updated Coding section to include ICD-10-CM diagnosis codes Z36.0-Z36.9. HIFU or MRgFUS has also been studied as a potential treatment of various cancers. Rebillard X, Gelet A, Davin JL, et al. 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