Tuesday, July 16, 2024

Does Medicare Cover Hifu For Prostate Cancer

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How The Hifu Procedure Works

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HIFU is considered a minimally invasive procedure for the treatment of low-risk, localized prostate cancer and for prostate cancer recurrence in the prostate gland. HIFU is an option for men who are not candidates for open surgery or dont want to undergo surgery or radiation therapy.

HIFU uses high-intensity sound waves to heat and destroy cancer cells. It is not indicated for cancer that has spread beyond the prostate.

Then during the procedure, an ultrasound probe is inserted into the rectum and directs heated sound waves through the walls of the rectum to destroy cancer cells. With the use of MRI or ultrasound imaging, the sound waves are aimed toward the cancer cells, heating up to temperatures as high as 90 degrees to ablate the targeted cells.

HIFU is a 3-hour procedure performed under anesthesia with an additional 3 hours in recovery. Pain medication and antibiotics are prescribed after surgery and up to 1 week of downtime is required after the procedure.Potential Side Effects of HIFU Affect Each Man Differently

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Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. This condition causes pain in the lower back and groin area, and may cause urinary retention. Symptoms include leaking and discomfort. In severe cases, a catheter may be required to relieve the symptoms. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. If these do not work, your symptoms could progress and become chronic.

An acute bacterial infection can cause a burning sensation. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. The symptoms of acute bacterial prostatitis are similar to those of CPPS. Patients may experience a fever or chills as a result of the infection.

American Hospital Association Disclaimer

The American Hospital Association has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

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What You Need To Know About Hifu For Prostate Cancer

· Not FDA Approved in U.S. to Treat Prostate Cancer ONLY FDA Approved for Prostate Tissue Ablation

· Touted as Non-invasive, however it is Minimally Invasive

· Requires Anesthesia

· Not Covered by Most Insurance Companies

· No Long Term Studies to Determine Safety and Effectiveness

HIFU is NOT FDA approved to treat prostate cancer. The Center for Devices and Radiological Health at the FDA reports that HIFU was approved recently for prostate tissue ablation , it has never been approved in the U.S. to treat prostate cancer.

How Long Is The Hifu Procedure

Medicare Coverage of HIFU treatment?

The procedure typically takes 2 to 4 hours depending on the size of your prostate. After your brief recovery from your outpatient HIFU procedure you can be discharged home the same day. Thats a remarkable contrast to the hospitalization required for radical prostate surgery or radiation treatment that can take up to 7 weeks to complete.

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Medicare Expands Treatment Options For Patients With Advanced Prostate Cancer


Medicare patients with metastatic prostate cancer can get a first-of-its kind treatment just approved by the Food and Drug Administration, under a final coverage decision issued today by the Centers for Medicare & Medicaid Services .

Autologous cellular immunotherapy, known clinically as sipuleucel-T, is marketed in the United States as Provenge, for treating some forms of prostate cancer in seriously ill patients. Todays decision is effective immediately.

Provenge activates a patients own immune system to defend him against prostate cancer. The treatment consists of a multi-day regimen in which the patients white blood cells are collected and exposed to proteins that direct the white blood cells to fight prostate cancer cells. After the patients cells are treated, the patient receives his own cells back into his body in order to stimulate his immune system to fight the prostate cancer. This regimen is repeated over several weeks for a total of three treatments.

We are optimistic that innovative strategies may improve the experience of care for our beneficiaries who have cancer, said CMS Administrator Donald M. Berwick, M.D. CMS is dedicated to assuring that these patients can seek the treatments they need in accordance with their wishes.

Are You A Candidate For Hifu

HIFU is best for people with intermediate-risk prostate cancer that hasnt spread and is limited to one area of the prostate. Your urologist will help you understand your specific risks and treatment goals to help you make the best decision for you.

We dont recommend HIFU for cancer that:

  • Has spread beyond the prostate gland or into lymph nodes
  • Is large or involves both sides of the prostate

In these situations, whole-gland therapies, such as prostatectomy or radiation, may be best.

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Who Qualifies For Hifu

Ideal candidates for HIFU are those who have early stage , low-grade cancer that is confined to the prostate, and that is visible on an MRI or ultrasound. A PSA level below 20ng/mL is also preferred. HIFU is used to treat a single tumor or part of a large tumor and is not meant for those whose cancer has spread beyond the prostate. If you are interested in HIFU, please contact the Mount Sinai Department of Urology at 212-241-9955.

Be Careful Of Practices Or Institutions That Tell Your Hifu Procedure Will Be Covered By Your Insurance Plan

HIFU prostate cancer treatment offers non-invasive alternative

This is not true. It is typically stated by doctors or facilities who are just starting to perform HIFU and have little or no experience with patient insurance issues. Dr. Pugach has been performing HIFU for 17 years. He is one of most experienced HIFU practitioner in the world. Based on this experience, you can trust the information we give you. Some practices may lead you to believe your insurance plan will pre-authorize your procedure or definitely pay for it afterward. This is not true so be sure you do not find yourself in an uncomfortable financial situation after or just before your procedure!

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What Are The Advantages Of Hifu Treatment

The advantage of the HIFU procedure for prostate cancer therapy is that it can cure cancer without the two common, life-altering side effects that radical surgery and radiation can cause:

  • Loss of bladder control
  • Erectile dysfunction
  • HIFUs precise, computer driven robotic treatment console minimizes the risk of complications with precise, targeted energy that destroys prostate tissue.
  • HIFU is completely radiation free. Unlike radiation, ultrasound energy is non-ionizing, meaning it will not harm any tissue outside of the target area.

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An enlarged prostate can also be the cause of other problems. If the enlarged prostate is causing symptoms, the best treatment would be a natural remedy. In the meantime, there are treatments for a wide range of conditions that cause a man to experience pain. A common surgical procedure involves an electric loop, laser, or electro-stimulation. The procedure is a safe and effective option for treating enlarged or symptomatic BPH.

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Reimbursement & Hifu For Prostate Cancer

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In the summer of 2017, the Centers for Medicare & Medicaid Services issued a reimbursement code that may help some HIFU patients cover some of the expense of paying for the HIFU treatment. This was great news for Medicare patients who were looking for a way to get reimbursement for some of the cost of the procedure. Not only that, this reimbursement code marks a significant milestone as it means that HIFU as a treatment for localized prostate cancer is becoming more accessible to men in the US and to physicians interested in providing their patients with non-invasive treatment options.

However, it is important to remember that this reimbursement code does not mean that HIFU is all the sudden a procedure that is completely covered by Medicare or by private insurers. In fact, the code that was issued only applies to reimbursement for the facility where HIFU is delivered.

In order to make it as easy to understand as possible, we pulled together some helpful information about how Medicare codes are defined and how to better understand the C-code that was issued for HIFU ablation of the prostate.

At this time, the code does not apply to commercial insurers therefore, patients not covered by Medicare seeking to pursue HIFU should expect to pay treatment expenses out of pocket.

For more information on reimbursement and coding visit our Reimbursement page or call us today at 1-877-884-HIFU .

Medicare And Cancer Treatment Coverage

Why Haven

In 2009, just over 50 percent of all cancers occurred in individuals 65 years old or older, according to research published in the American Journal of Preventive Medicine. By the year 2030, though, that number is expected to grow to 70 percent. What is the cause of this level of increase?

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Medicare Advantage Coverage For Surgery

Medicare Advantage plans are administered by private companies that contract with the federal government. Plans must include the same basic care as Original Medicare but often bundle other benefits such as vision and dental into a single plan.

Medicare Advantage plans may require you to use hospitals and doctors within the plans network for your surgery. Prior authorization is usually required.

Medicare Advantage plans may also have different deductibles, coinsurance and copayments for surgery than Original Medicare.

For example, the AARP Medicare Advantage Choice plan features a $295 per day coinsurance payment for inpatient hospital care . This is in addition to the standard Medicare Part A deductible of $1,484 in 2021.

After day six, there are no coinsurance payments with this plan.

A different Medicare Advantage plan UnitedHealthcare Dual Complete® RP features $0 copayments for each Medicare-covered hospital stay for unlimited days, as long as the hospital is within the plans network.

In contrast, Original Medicares inpatient hospital policy features a $0 coinsurance payment for the first 60 days of inpatient care after you meet the Part A deductible.

Contact your specific Medicare Advantage plans customer service department or consult your annual evidence of coverage manual for details about inpatient and outpatient surgery coverage.

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Hifu Provides An Alternative

When a patient is diagnosed with prostate cancer that has not spread beyond the walls of the prostate, there are three ways to manage the cancer. The first is watchful waiting or active surveillance. Often, prostate cancer grows slowly and is nonaggressive. The cancer may not impact the patient during his lifetime. Despite the slow progression of this disease, some patients are still uncomfortable with a diagnosis of cancer and prefer treatment. The second option is complete surgical removal of the prostate, or radical prostatectomy. The third option is radiation therapy which requires multiple rounds of radiotherapy over several months. Both surgical removal and radiation have been the standard of care for many years.

For men diagnosed with localized prostate cancer, HIFU provides another alternative. HIFU is a minimally invasive, outpatient procedure. No incisions are made during treatment. Think of holding a magnifying glass above a leaf on a sunny day. The suns rays shine through the lens and cause the leaf to burn. The procedure is precise and effective.

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Contact Your Pasadena Oncology Center Today

Any cancer diagnosis is scary, but at Pasadena CyberKnife Center, we are here to support you through your entire treatment process. Were proud to provide world-class cancer treatments to patients throughout the Pasadena and greater LA area. With our state-of-the-art radiation therapy cancer treatments, we are able to treat patients with a wide variety of conditions.

If you or a loved one have recently been diagnosed with cancer, there is hope. To learn more about CyberKnife, call us today at 768-1021 to schedule a consultation. Our contact page also provides information on our location and hours. Let the cancer experts at Pasadena CyberKnife Center help you beat cancer to reclaim a healthy, happy life.

What Is The Recovery Process

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During the first several weeks after the procedure patients typically experience urinary symptoms such as frequency and/or urgency to void. In the first one to two months patients may pass small amount days of blood, old prostate tissue or mucus-like material in the urinary stream. A urinary catheter is inserted and typically stays in your bladder for 2 weeks. Unlike catheters used after radical surgery, it does not go through the urethra so its far more comfortable and carries a much lower risk of infection. Dr. Pugach and his HIFU team will explain all of this to you in more detail when you come in for your consultation.

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How To Increase Your Chances For Coverage If You Think The Testing Or Treatment May Be Denied

Take time to fully understand your health insurance plan before you begin treatment. This will help you to avoid surprises once youve started treatment. Here are some steps to take:

  • Obtain an updated, complete copy of your health plan .
  • Ask questions. Talk with your employers health benefits department. Call your health plans customer service line. Ask about any policies not included in the benefit book, such as appeal processes and how denials are formulated. Explore what legal health insurance requirements your state mandates.
  • Get a letter of referral from your physician that clearly indicates that he or she strongly recommends a particular treatment.
  • If coverage is an issue with your HMO, consider switching to a PPO plan with the same provider. The best time to make the change is during open enrollment or at policy renewal time.
  • Shop around for other insurance companies and switch to a provider that is known for approving the treatment being recommended. However, be careful not to cancel your original coverage until the new coverage takes effect.
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    Medicare Supplement Plans For Cancer Treatment

    Original Medicare coverage for cancer treatment does come with costs you need to pay, such as the coinsurance and deductibles mentioned above. If youre enrolled in Medicare Part A and Part B, you may be able to sign up for a Medicare Supplement plan to help pay for Original Medicares out-of-pocket costs associated with your cancer treatment. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles.

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    How Does Green Light Laser Therapy Work

    The doctor will insert a small flexible fiber into the patients urethra through the cystoscope. The small fiber carries laser energy that can remove prostate tissues quickly.

    Once the prostate tissue is removed, the patient will be able to urinate properly as the urine is now able to pass through freely.

    Before the procedure, your healthcare will give you anesthesia, so there will be little to no discomfort and pain. The doctor will also prescribe pain medications to the patient.

    What Is The Cyberknife Vsi Treatment Process

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    Pasadena Cyberknife® robotic treatments involve a team approach in which several specialists from our oncology center participate.Prior to the procedure, the patient is imaged using a high-resolution CT scanner, to determine the size, shape, and location of the tumor. Following the CT scan, the image data is digitally transferred to the Pasadena CyberKnife VSI Systems workstation, where the treatment planning begins.

    Your Board Certified physician then uses the CyberKnife VSI software to generate your specific treatment plan. The plan is used to match the desired radiation dose to the identified tumor location while limiting radiation exposure to the surrounding healthy tissue. Once the treatment plan has been developed, you are ready to undergo treatment.

    The process of prostate cancer radiation treatment with CyberKnife begins by placing the fiducial markers. These tiny golden seeds help the CyberKnife system locate your tumor and track its movements.

    Next, your treatment team creates your treatment cradle. The cradle is made from soft material that conforms to your shape. Youll lie in the treatment cradle during each session. It will help you maintain your physical position from one treatment to the next and ensure your comfort during treatments.

    Each treatment session will last between 20 and 45 minutes, once per day for five days or less. Patients may experience some minimal side effects, but those often go away within the first week or two after treatment.

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    Other Hifu Related Expenses

    Your initial prostate cancer office visit with Dr. Robert Pugach may be covered by Medicare. We are happy to check your Medicare benefits without charge. Just call , so we can verify if your Medicare Plan will cover our consultation.

    The cost of pre-HIFU medical clearance and any lab tests required by your anesthesiologist are not included in HIFU fees. We will outline all of this for you in detail so there are no unforeseen financial surprises. The cost of this testing is usually very nominal.

    How Medicare Covers Prostate Health Psa Tests And Surgery

    The odds are that someone in your life has already been diagnosed with prostate cancer. One of the most common cancers, prostate cancer will affect one in seven or eight American men, usually later in life, according to the Centers for Disease Control.

    The good news is that survival rates are highnearly 100 percentwhen prostate cancer is treated before it spreads to other parts of the body, according to the American Cancer Society. Thats why its important to get regular prostate cancer screenings, including prostate-specific antigen tests, when youre in the target age group, which the CDC defines as 55 to 69 years old. Of course, you may be wondering whether Medicare pays for the PSA test. Fortunately, the answer is yes, it does.

    Furthermore, if your screening reveals cancer, Medicare covers prostate surgery and other treatment just as it covers costs for treating other cancers. Lets look at the ins and outs of coverage for this important health issue.

    What Prostate Cancer-Screening Services Are Covered?After you turn 50, Medicare Part B will cover preventive prostate cancer screening. That means that once a year, Medicare Part B covers a PSA test and a digital rectal exam .

    If you visit a doctor who doesnt accept assignments, you may be charged a fee for the doctors services to administer the PSA, but you wont be charged for the test itself.

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