This includes terms that decide who can get coverage. They get this amount no matter how many patients they see. 2011;81(4):e601-e606. Nakayama H, Sugahara S, Tokita M, et al. A mechanical stop switch and a mechanical direction change switch are included in the allowance forthis componewnt. A single doctor and care team coordinate all of your care. A static, pre-fabricated wheelchair seat or back cushion not meeting the definition of general use, skin protection, or positioning cushion is considered not medically necessary (see background section: Rollabout chair seat and back cushions: Consistent with Medicare rules, Aetna does not allow separate payment for a wheelchair seat and back cushion for use with a rollabout chair. It can only be used with an expandable controller. They can offer general or acute care. CPT is a registered trademark of the American Medical Association. 2003;40(5):309-315. Batteries: U-1 battery, 22 NF deep-cycle lead acid battery, gel battery or Group 24 battery. The limit is based on data Aetna receives. It also can be offered separately from the Medicare plan. Language services can be provided by calling the number on your member ID card. Vargas CE, Hartsell WF, Dunn M, et al. This insurance covers basic medical needs. 2019;10(15):3315-3322. It lists doctors and health care professionals in the network. ABVD alone versus radiation-based therapy in limited-stage Hodgkin's lymphoma. Health insurers use these documents to explain the basis for coverage decisions for their members. If it is a verbal order, it must be put in writing by the pharmacy. This is any type of job for which a person is qualified. Check your plan documents for more details: Your health plan documents will tell you how we pay for out-of-network care. It can grow and spread in the body. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. J Radiat Res. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. This is also called Medicare Part B. People sometimes need to prove they have had this so they can be fully covered by a new plan. It can be paid to the insured person after an accidental injury. 2018;100(4):972-979. Proton therapyA systematic review of clinical effectiveness. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. Beginning in 2014, the Affordable Care Act requires that most people have health insurance for themselves and their dependents. Center for Medicare & Medicaid Services (CMS). J Gastrointest Oncol. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. The cane or walker should be appropriately fitted to the individual for this evaluation. Ambulatory care. Choi YJ, Kim TW, Kim S, et al. These funds are health reimbursement arrangement (HRA), health savings account (HSA), retiree reimbursement account (RRA), flexible spending account (FSA) and first dollar plan. Five-year biochemical results, toxicity, and patient-reported quality of life after delivery of dose-escalated image guided proton therapy for prostate cancer. Members can go outside the group if the group can't handle their medical needs. A solid support base for a seat cushion is a rigid piece of plastic or other material which is attached with hardware to the seat frame of a wheelchair in place of a sling seat. The ordinary and usual professional services rendered by a physician during a professional visit for treatment of an illness or injury. IMRT, passively scattered proton therapy (PSPT), and spot scanning proton therapy (SSPT) plans were performed for 4 different target volumes: Most radiation therapies utilize photons lightweight particles that damage cancerous cells. This lets workers who were disabled return to work part time. The authors concluded that dynamic seating may address numerous positioning challenges in clients with increased muscle tone in conjunction with an appropriate seating system and mobility base. cursor: pointer; Ch. License to sue CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Li J, Du H, Li P, et al. In a randomized clinical study, Laramore and associates (1993) compared the effectiveness of fast neutron radiotherapy versus conventional photon and/or electron radiotherapy for unresectable, malignant salivary gland tumors. or greater, any height, including any type mounting hardware, Custom fabricated wheelchair back cushion, any size, including any type mounting hardware, Replacement cover for wheelchair seat cushion or back cushion, each, Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable, Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable rancho type, Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, reclining, Wheelchair accessory, shoulder elbow, moblie arm support attached to wheelchair, balanced, friction arm support (friction dampening to proximal and distal joints), Wheelchair accessory, shoulder elbow, mobile arm support, monosuspension arm and hand support, overhead elbow foremarm hand sling support, yoke type suspension support, Wheelchair accessory, addition to mobile arm support, elevating proximal arm, Wheelchair accessory, addition to mobile arm support, offset or lateral rocker arm with elastic balance control, Wheelchair accessory, addition to mobile arm support, supinator, Lightweight wheelchair [not covered for sport wheelchairs], High strength, lightweight wheelchair [not covered for sport wheelchairs], Ultralightweight wheelchair [not covered for sport wheelchairs], Standard-weight frame motorized/power wheelchair, Standard-weight frame motorized/power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking [not covered for stair climber], Lightweight portable motorized/power wheelchair, Detachable, non-adjustable height armrest, each, Detachable, adjustable height armrest, base, replacement only, each, Detachable, adjustable height armrest, upper portion, replacement only, each, Elevating legrest, lower extension tube, each, Elevating legrest, upper hanger bracket, each, Seat height less than 17 in. It has changes in it that affect the main policy. A power mobility device is considered not medically necessary if the underlying condition is reversible and the length of need is less than 3 months (e.g., following lower extremity surgery which limits ambulation). Number: 0070 Policy. Arlington, VA: ASTRO; 2017. Int J Radiat Oncol Biol Phys. It provides health care coverage. Treating providers are solely responsible for medical advice and treatment of members. above are not met. A non-proportional, contact switch head control interface is one in which a person activates one of three mechanical switches placed around the back and sides of their head. Radiother Oncol. Protons vs photons for brain and skull base tumors. Noridian Administrative Services, LLC. Moraes FY, Chung C. Radiation for skull base meningiomas: Review of the literature on the approach to radiotherapy. A caretaker, for example a family member, may be compensatory, if consistently available in the individual's home and willing and able to safely operate andtransfer the individual to and from the wheelchair and to transport the individual using the wheelchair. It is usually used during tests to find out how potential new drugs and treatments will work. A period of consecutive days during which medical benefits for covered services are available to the plan member. above. Others have four tiers, three tiers or two tiers. ", "The data on the effect of proton treatment vs. photon radiotherapy on radiation necrosis and pseudoprogression in patients with primary intramedullary spinal cord gliomas are too imprecise to draw a firm conclusion;", "There is evidence of very low level (1 study, 98 patients) that proton treatment is associated with more dermatologic toxicity (skin colour changes, patchy atrophy, telangiectasia) than photon radiotherapy in patients with stage I breast cancer. BlueCross BlueShield Association (BCBSA), Technology Evaluation Center (TEC). National Comprehensive Cancer Network (NCCN). No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Neuro Oncol. To buy the card online, go to the Aetna Vital Savings webpage. Also known as National Committee for Quality Assurance. 2014;37(5):438-443. At this time, the plan accepts people new to Medicare. In some health plans, a person must choose a PCP to coordinate care. Qualified medical expenses (also known as eligible medical expenses). 2012;103(1):25-31. - Tilt, recline, elevating legrests, seat elevators, or standing systems that may be added to a PWC to accommodate a members specific need for seating assistance. Visual acuity (VA) and radiation complications, which included radiation maculopathy, papillopathy, retinal detachment, and rubeosis, were assessed. Henderson RH, Hoppe BS, Marcus RB Jr, et al. The pay does not include bonuses, overtime or other extra pay. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. If you have a PPO or HMO Medicare Advantage Plan, you cannot purchase a stand-alone drug plan. It limits the rules a group health plan can place on benefits for pre-existing health problems. 2015;7(2):5855. Proton beam radiation therapy. Also known as an outpatient procedure. These are plan documents. A caster is a smaller wheel that is in contact with the ground during normal operation of the power wheelchair and which not directly controlled by the motor. National Comprehensive Cancer Network (NCCN). Clinical application of proton beams in the treatment of uveal melanoma: The first therapies carried out in Italy and preliminary results (CATANA Project). Proton beam radiotherapy for anal and rectal cancers. Long-term results of proton beam therapy for carcinoma of the uterine cervix. The prescribed dose to the parametria was 2.12 Gy up to 59.36 Gy in 28 fractions as a simultaneous boost. Proton beam radiation as salvage therapy for bilateral colorectal liver metastases not amenable to second-stage hepatectomy. 2012;11(6):607-614. This is a law. The App is available on ios and Android. 2018;3(3):314-321. Your benefits plan determines coverage. Riechardt AI, Klein JP, Cordini D, et al. Seeing her parents and grandparents age made Amie ask herself, Would this be good enough for my loved ones? In her spare time, Amie enjoys outdoor adventures and spontaneous road trips. A mechanical shear reduction feature consists of two separate back panels. So do people who cannot get health benefits from their employer or other group. For members who do not have special skin protection or positioning needs, a power wheelchair with Captains Chair provides appropriate support. Medicare Supplement Insurance (Medigap) policy with prescription drug coverage, Federal Employee Health Benefits (FEHB) Program, Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), State Health Insurance Assistance Program. Also known as a contract. The amount they charge is based on the person's ability to pay. Esophagus. 2019;58(12):1752-1756.