Your insurance plan may cover your initial consultation with Dr. Pugach. We will gladly check your benefits at no cost to you. Simply call 844.443.8362 to get your insurance verified.
Any HIFU prices do not cover the cost of pre-HIFU medical clearance or any lab tests ordered by your anesthesiologist.
We’ll go through everything with you in detail so there are no financial surprises.
This type of examination is usually quite inexpensive.
We are aware that HIFU is a costly operation. It is not yet covered by insurance, unlike some other prostate cancer treatments. That’s because it usually takes roughly 5 years from the time a surgery is approved by the FDA to the time insurers pay for it. In the case of HIFU, this means that coverage will most likely begin with extremely limited coverage in 2021.
If you have prostate cancer and want to avoid the adverse effects of surgery or the high recurrence rates associated with radiation, HIFU is typically the best alternative. It was for Dr. Robert Pugach, who invested in his own future health in 2017 by having an HIFU surgery. (You can read his tale here.) When you come in for your in-person, online, or phone consultation, we’ll be pleased to assist you in determining the cost of HIFU and its safety profile.
Is HIFU covered by insurance 2019?
HIFU is not covered by any commercial insurance plan; in fact, most plans explicitly declare that it is not covered. HIFU Prostate Services is out-of-network with all insurance providers in the United States, thus we won’t be able to help you file for reimbursement.
Does Medicare cover HIFU?
Is HIFU covered by Medicare? Yes, Medicare pays the facility cost for all Medicare patients treated at our HIFU Center of Excellence at Lakewood Ranch Center in Bradenton, Florida, regardless of their home state.
Does insurance cover focal laser ablation?
MRI Focal Laser Ablation (FLA or Blue Light laser) is a new, very experimental minimally invasive focal prostate cancer treatment that employs MRI guidance to accurately put a laser fiber through the rectum into a prostate cancer tumor. The laser radiation generates heat, which ablates (destroys) the tumor when it is activated. Throughout the therapy, magnetic resonance imaging is used to ensure that the target tumor is thoroughly covered while causing no injury to adjacent tissues. Beyond two years, there is a scarcity of published data on effectiveness. Re-treatment is frequently necessary.
The major prostate tumor (or index tumor) is destroyed with MRI Focal Laser Ablation while healthy tissue is spared. Its precision permits normal tissues and structures next to the ablation zone to be preserved. This suggests that the therapy has little effect on urine and sexual functioning. To put it another way, the goal is to keep prostate cancer under control while preserving a man’s quality of life.
MRI Focal Laser Ablation is an outpatient technique that is done under sedation and local anesthesia. There is no surgery or radiation involved, and the treatment takes roughly 2 hours to complete. MRI imaging and MRI guided fusion biopsy can be used to monitor the ablated tumor at intervals chosen by the clinician. MRI Focal Laser Ablation can be repeated if a new tumor develops. Furthermore, it does not rule out the possibility of future prostate cancer treatment.
Although laser ablation has been licensed by the FDA for soft tissue ablation, it has never been evaluated for the treatment of prostate cancer. Medicare and most major insurance companies do not cover this treatment.
For very small distinct cancers in the prostate that are well seen by MRI, MRI Focal Laser Ablation may be investigated. The Scionti Prostate Center’s Advanced Diagnostic procedures are critical in identifying individuals with focal distinct tumors that could be treated with Focal Laser Ablation.
Has HIFU been approved by the FDA?
The Sonalleve MR-HIFU system (Profound Medical Inc.) was authorized by the Food and Drug Administration on November 27, 2020, for the treatment of osteoid osteoma in the extremities.
MR-guided High Intensity Focused Ultrasound (MR-HIFU) is an image-guided treatment that combines high-intensity focused ultrasound ablation with real-time temperature monitoring during sonication.
The clinical data suggest the Sonalleve MR-HIFU system’s potential utility in the ablation of painful osteoid osteoma. In a trial of nine patients treated with MR-HIFU, the efficacy was assessed without any technical issues or major side effects. Within four weeks of treatment, their pain scores had decreased statistically significantly. After four weeks, eight of nine patients had not used any pain medication.
Under certain circumstances, the device should not be utilized. View the Summary of Safety and Probable Benefit Document for the Sonalleve MR-HIFU system for complete details, including warnings and precautions. The Sonalleve MR-HIFU system has a Summary of Safety and Probable Benefit Document.
What is the CPT code for HIFU?
The American Medical Association (AMA) has approved a category 1 CPT code for HIFU treatment (55880) that permits physicians, facilities, and anesthesiologists to bill for their services related to HIFU treatment beginning January 1, 2021.
How much does focal laser ablation cost?
Until recently, newly diagnosed PCa (prostate cancer) patients had a poor prognosis “It’s either all or nothing.” The patient was told that if there was no indication of dissemination outside the capsule, he could undergo either: (1) “(2) Active Surveillance, which means monitoring the issue forever; or (3) definitive treatment, which requires prostatectomy or some type of radiation. Option 1 would be recommended for males with more aggressive PCa, possibly in conjunction with Androgen Deprivation Therapy. Option 2 Active Surveillance may be chosen for people with low risk characteristics, such as Gleason Score 6.
What about males who are at a low-to-moderate risk? Based on a 12-year follow-up, the Prostate Cancer Intervention Versus Observation Trial (PIVOT) found no statistically significant gain in longevity. “According to a meta-analysis of 31,000+ prostate studies conducted by the Prostate Cancer Results Study Group, directed by Peter Grimm, DO, Seattle, WA, the risk of recurrence is considerable. “As a result of the dangers of impotence, wearing pads, and other side effects and complications, there is almost certain to be a loss in Quality of Life.” Option 1 is clearly excessive treatment for these men.
But what about the second option? The urologist is frequently unsupportive, and there is concern that AS will worsen and spread. As a result, many people consider Option 2 to be under-treatment.
There has recently been a surge in interest in focal treatments that target the middle ground. Is there a method for treating present clinically significant lesions while conserving the rest of the prostate that is both safe and effective? If so, could it be done with no or little risk of problems and side effects? And, if PCa recurs in the future, what are the therapy choices, such as targeted or, if necessary, surgery, radiation, and other treatments?
Recent advancements in 3T multiparametric (mp) MRI technologies are being used for both diagnosis and treatment, which is a good thing. FLA is a procedure that uses a laser to ablate the lesion(s) and thermometry to monitor the neighboring healthy tissue that is preserved inside an MRI scanner. The National Institutes of Health, the University of Chicago, UCLA, Desert Medical Imaging, and the University of Toronto have all completed or are currently conducting successful clinical trials. FLA has also been licensed for commercial usage in the United States. The University of Texas Medical Branch – Galveston (Eric Walser, MD) and the Sperling Prostate Cancer Center – with facilities in New York City and Florida – are two of the leading centers (Dan Sperling, MD).
In addition, a survey of 100 patients who have had FLA was recently completed, rather than a clinical trial: “A Survey of 100 Focal Laser Ablation Patients by a Healthcare Actuary.” The following are some of the survey’s significant findings:
1) Patients seek a treatment choice that leaves them with a lot of options in the future and has few adverse effects. This is a substitute for doing “All or nothing” is a paradigm revolution in the making.
2) Patients are well-educated, belong to a higher socioeconomic category, and are at low to moderate risk.
3) 95 percent of patients are treated in a retail context, while 5% are enrolled in clinical studies.
4) Only 15% of people first learnt about mp MRIs from a doctor.
5) MRI and Guided Biopsy are effective in 99 percent of cases, with no or little adverse effects.
6) Only 6% of people first learnt about FLA from a doctor.
7) 99 percent of respondents said they would recommend FLA to a friend.
8) 87 percent said FLA worked and there was no recurrence.
9) 81 percent indicate they don’t have any Erectile Dysfunction (ED) and another 13% think it’s too early to tell.
10) 86 percent of respondents indicate they have no serious urinary dysfunction, while another 6% think it is too early to tell.
11) Nearly all (94%) say they were able to resume their normal daily activities within a week, with many saying they were able to do so in only a few days.
12) What would they have done differently if they could go back in time? 88 percent said they don’t know or don’t care… and say they’d skip the TRUS (also known as Random or Blind) Biopsy.
John Fortin, a Healthcare Actuary in Atlanta, GA, is the lead author. Wayne Williams and Henry Oat provided design and review assistance. All three males suffer from FLA. In 2009, Mr. Williams became the second prostate FLA patient in the United States. The surgery went well, with no recurrences, side effects, or difficulties. The cost of the operation varies from from $15,000 to more than $30,000, yet it is still regarded reasonable “Carriers refer to it as “experimental and investigational.”
How much does HIFU cost in Canada?
When Robert Abelson was diagnosed with prostate cancer and informed he needed surgery, he was terrified of the potential side effects, which included impotence and urinary incontinence. As a result, the 59-year-old Toronto interior designer embarked on the hunt for alternatives.
He learned about HIFU – high-intensity focused ultrasound – at the Man to Man prostate cancer support group and decided to discuss it with his urologist.
Mr. Abelson explained, “He told me HIFU was pricey and not for everyone.” However, after weighing the benefits and drawbacks, he decided to go with the method.
“Call me a coward, but I was looking for a method to avoid surgery or radiation, particularly the adverse effects that everyone talks about,” he explained.
Mr. Abelson drove to a clinic in downtown Toronto early on December 8, 2007. At 7:30 a.m., he received a spinal anesthesia (an epidural), went through the ultrasound procedure, relaxed for a while, ate lunch with his wife, and then walked out at 2:30 p.m. without a prostate.
“We kill the tissue by boiling it with ultrasound, rather than chopping out the prostate or destroying it with radiation,” said Jack Barkin, a urologist and partner at Can-Am HIFU. (It’s the same ultrasound that’s used to break up kidney stones.) “HIFU has the same cure rate as other procedures but none of the negative side effects,” he stated. “And the best part is that patients walk in and walk out within a few hours.”
HIFU is not for every guy with prostate cancer, according to Dr. Barkin.
It’s best for men with prostate cancer that hasn’t spread outside the gland, whose prostate has grown to the 35- to 50-gram range, and a low to moderate Gleason score (a scale used to judge severity).
And it’s currently only available to men who can afford it. Because HIFU is not covered by any provincial insurance plan in Canada, the surgery costs around $22,000 and must be paid out of pocket.
What is high intensity focused ultrasound (HIFU)?
HIFU, or High-Intensity Focused Ultrasound, is an FDA-approved, minimally invasive therapy for the treatment of prostate cancer that provides customized treatment with significantly fewer side effects.
How does high intensity focused ultrasound (HIFU) work?
The delivery of precise and focused sound waves to a targeted location of damaged prostate tissue is how HIFU eliminates prostate cancer. Ultrasound energy, not radiation, is used to damage the targeted tissue with this technology. Ultrasound energy, or sound waves, is sent through the rectal wall and aimed at specific areas within the prostate that have been discovered by MRI and confirmed by ultrasound. This targeted, minimally invasive method to prostate cancer treatment keeps healthy tissue intact and reduces the risk of side effects.