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Endoscopic Ultrasonography (EUS) [For the List of Services and Procedures That Need Preauthorization, Please Refer To

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Endoscopic Ultrasonography (EUS) [For the List of Services and Procedures That Need Preauthorization, Please Refer To Clinical Medical Policy Department Clinical Affairs Division Endoscopic Ultrasonography (EUS) [For the list of services and procedures that need preauthorization, please refer to http://www.mcs.com.pr. Go to “Proveedores”, and clic “Políticas Médicas”.] Medical Policy: MP-SU-03-08 Original Effective Date: June 12, 2008 Revised: May 3, 2021 Next Revision: April, 2022 This policy applies to products subscribed by the following corporations, MCS Life Insurance Company (Commercial), and MCS Advantage, Inc. (Classicare) and Medical Card System, Inc., provider’s contract; unless specific contract limitations, exclusions or exceptions apply. Please refer to the member’s benefit certification language for benefit availability. Managed care guidelines related to referral authorization, and precertification of inpatient hospitalization, home health, home infusion and hospice services apply subject to the aforementioned exceptions. DESCRIPTION Endoscopy Ultrasonography (EUS) combines endoscopy and ultrasound in order to obtain images and information about the digestive tract and the surrounding tissue and organ. Endoscopy procedure is the insertion of a long flexible tube via the mouth or the rectum to visualize the digestive tract. Whereas ultrasound uses high frequency sound waves to produce images of the organs and structures inside the body such as ovaries, uterus, liver, gallbladder, pancreas and aorta, etc. Traditional ultrasound sends sound waves to the organ(s) and back with a transducer placed on the skin overlying the organs(s) of interest. Images obtained by traditional ultrasound are not always on high quality. In EUS a small ultrasound transducer is installed on the tip of the endoscope which is inserted into the upper or the lower digestive tract and one can obtain high quality ultrasound images of the organs inside the body (MedicineNet, Inc., 2021). Endoscopic Ultrasound (EUS) originally was developed as a diagnostic modality but rapidly gained a role for a variety of therapeutic applications. EUS has been used increasingly for drainage of pancreatic fluid collections, treatment of cystic lesions of the pancreas, EUS-guided cholangiopancreatography, localized therapy for pancreatic tumors, and treatment of subepithelial lesions and gastric varices (UpToDate®, 2021). COVERAGE Benefits may vary between groups and contracts. Please refer to the appropriate member certificate and subscriber agreement contract for applicable diagnostic imaging, DME, laboratory, machine tests, benefits and coverage. INDICATIONS Medical Card System, Inc. (MCS) considers the use of Endoscopic Ultrasonography (EUS) medically reasonable and necessary, for Both Commercial and Classicare (Advantage) Lines of Business (LOB), for Any of the following indications: This document is designated for informational purposes only and is not an authorization, or an explanation of benefits (EOB), or a contract. 1 Medical technology is constantly changing and we reserve the right to review and update our policies periodically. Medical Card System, Inc. 1 All Rights Reserved® Clinical Medical Policy Department Clinical Affairs Division 1. Staging tumors of the gastrointestinal tract, pancreas, and bile ducts. 2. Evaluation and tissue sampling of abnormalities of the gastrointestinal (GI) tract wall or adjacent structures. 3. Evaluation of abnormalities of the pancreas, including masses, pseudocysts, cysts and chronic pancreatitis. 4. Evaluation of abnormalities of the biliary tree. 5. Providing endoscopic therapy of the gastrointestinal tract under ultrasonographic guidance. 6. Staging tumors shown to be metastatic only when the results are the basis for therapeutic decision. 7. Evaluation of adenopathy and masses of the posterior mediastinum, or in the inferior mediastinum, with Endoscopic Ultrasonography-Fine Needle Aspiration (EUS-FNA). 8. Staging of patients with Non-Small Cell Lung Cancer (NSCLC), with Endoscopic Ultrasonography- Fine Needle Aspiration (EUS-FNA). 9. Placement of fiducials into tumors within or adjacent to the wall of the Gastrointestinal (GI) tract. 10. Treatment of symptomatic pseudocysts by creating an enteral-cyst communication. 11. To perform Celiac Plexus Blockade (CPB) or Celiac Plexus Neurolysis (CPN) as a means of achieving analgesia (i.e., Drug Delivery). 12. Providing access into the bile ducts or pancreatic duct, either independently or as an adjunct to Endoscopic Retrograde Cholangiopancreatography (ERCP). 13. Evaluation for chronic pancreatitis. 14. Evaluation of acute pancreatitis of unknown etiology. 15. Evaluation for perianal and perirectal disorders (anal sphincter injuries, fistulae, abscesses). 16. Evaluation of patients at increased risk of pancreatic cancer. CONTRAINDICATIONS/LIMITATIONS 1. To be performed at elderly patients with unstable cardiac or pulmonary conditions. This document is designated for informational purposes only and is not an authorization, or an explanation of benefits (EOB), or a contract. 2 Medical technology is constantly changing and we reserve the right to review and update our policies periodically. Medical Card System, Inc. 2 All Rights Reserved® Clinical Medical Policy Department Clinical Affairs Division 2. For staging of tumors, (e.g., of the GI tract, pulmonary, etc.) when prior imaging methods have confirmed metastasis (unless the results are the basis for therapeutic decisions). 3. When the risks to patient health or life are judged to outweigh the most favorable benefits of the procedure. 4. When adequate patient cooperation or consent cannot be obtained. 5. When the results will not contribute to a management choice. 6. For periodic follow-up of healed benign disease unless surveillance of a premalignant condition is warranted. 7. Contraindications to EUS-FNA include situations in which the FNA result would not affect management, inability to clearly visualize a lesion, a tumor mass or vessel interposed in the path between the needle and target, bleeding diathesis, and risk of tumor seeding. 8. When a perforated viscus is known or suspected. CODING INFORMATION FOR BOTH THE COMMERCIAL AND CLASSICARE (ADVANTAGE) LOB CPT® Codes (List may not be all inclusive) CPT® Codes Description 43231 Esophagoscopy, rigid or flexible; with endoscopic ultrasound examination 43232 Esophagoscopy, rigid or flexible; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s) 43237 Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of 43238 specimen(s) by brushing or washing, with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s), esophagus (includes endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures) 43240 Esophagogastroduodenoscopy, flexible, transoral; with transmural drainage of pseudocyst (includes placement of transmural drainage catheter[s]/stent[s], when performed, and endoscopic ultrasound, when performed) 43242 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s) (includes endoscopic This document is designated for informational purposes only and is not an authorization, or an explanation of benefits (EOB), or a contract. 3 Medical technology is constantly changing and we reserve the right to review and update our policies periodically. Medical Card System, Inc. 3 All Rights Reserved® Clinical Medical Policy Department Clinical Affairs Division ultrasound examination of the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to anastomosis) 43247 Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body(s) 43252 Esophagogastroduodenoscopy, flexible, transoral; with optical endomicroscopy 43253 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, with transendoscopic ultrasound-guided transmural injection, of diagnostic or therapeutic substance (s) (e.g., anesthetic, neurolytic agent) or fiducial marker(s) (includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis) 43259 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, with endoscopic ultrasound examination, including the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to anastomosis 44406 Colonoscopy through stoma; with endoscopic ultrasound examination, limited to the sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures 44407 Colonoscopy through stoma; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s), includes endoscopic ultrasound examination limited to the sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures 45341 Sigmoidoscopy, flexible; diagnostic with endoscopic ultrasound examination 45342 Sigmoidoscopy, flexible; diagnostic with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s) Colonoscopy, flexible, proximal to splenic flexure; with endoscopic ultrasound 45391
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