By Daniel Petkevich
Nov 21, 2022
If you’re a senior citizen on Medicare, you may be wondering how HIFU (high-intensity focused ultrasound) is covered. HIFU is a relatively new, non-invasive treatment that uses ultrasound waves to target and destroy cancer cells.
Unfortunately, Medicare does not offer comprehensive coverage for all the treatments that HIFU can help remedy. Let's walk through two of the most prominent examples as an illustration of the different ways Medicare might cover HIFU.
When most people picture an ultrasound, they typically think of imaging of someone's organs or sometimes of a pregnancy. But now, High-Intensity Focused Ultrasounds, or HIFU, can treat various conditions with precision and without causing much disruption in the body. HIFU is a non-invasive procedure that targets problematic areas, including brain tissue or tumors. HIFU is FDA approved, and clinical trials have shown great promise for its effectiveness in treating various types of cancer.
Rather than a typical ultrasound which uses sound waves to reproduce an image, these sound waves are more directed to interact with targeted areas to treat them. The sound waves are delivered using a ultrasound probe on or above your skin near the targeted tissue. The following image from the Cleveland Clinic shows how the procedure looks for treating prostate cancer.
The sound waves heat the targeted tissue, similar to a magnifying glass focusing a beam of light, and the increase in temperature destroys the problematic part. HIFU is an exciting advancement of technology, especially when you consider that many of the alternative treatments for similar afflictions often involve more invasive or damaging procedures.
The answer to this question depends on what you are treating. At the time of publishing, Medicare generally only covers HIFU when treating tremors associated with Parkinson's disease. HIFU for cancerous and benign tumors currently is not covered through Medicare.
Essential tremor, also known as kinetic tremor, are one of the most common side effects of Parkinson's disease. The shaking of the extremities, including head, hands, and voice, associated with tremors makes many daily activities more difficult for an estimated 10 million Americans. While little is known about the cause, tremors can be alleviated by targeting a small region deep in the brain.
In order to be eligible for this treatment, you must meet the following conditions:
You have been diagnosed with an essential tremor
You have tried at least two other medications to treat your tremor
The tremor affects your quality of life
You would be comfortable lying still in an MRI scanner for two to three hours
You are over the age of 22
Assuming you meet the conditions listed above, let's look into how Medicare can cover your procedure.
HIFU is an outpatient procedure, so your costs will be covered by Part B. Medicare covers 80% of the outpatient costs after you pay the deductible of $226, so you'll pay 20% (or less) of the remaining costs. Those with Medicare Supplement Plans (Medigap Plans) might pay less than 20% or nothing at all.
In the rare case that you are admitted to the hospital, you are responsbile for the Part A deductible of $1,600. Because it is a minimally invasive procedure, in all likelihood, you won't have to worry about inpatient costs.
Side effects from this procedure are rare, but include the following:
Temporary or permanent muscle weakness
Loss of balance
Numbness or tingling in the fingers or elsewhere in the body
HIFU is generally seen as a treatment option for those with prostate cancer. According to the Center for Medicare & Medicaid Services (CMS), coverage for HIFU in prostate cancer was retired starting on October 20th, 2022. If you want HIFU treatment for prostate cancer, you will have to pay the total cost of the procedure out-of-pocket.
There was a period of time when Medicare was offering more coverage of HIFU in prostate cancer, but over the last couple of years, Medicare has scaled back their coverage and the reimbursement for facilities that can perform this procedure.
According to Western States HIFU, starting in 2019 the reimbursement rate was so low that it would not cover the costs of the supplies needed to perform the procedure. They now offer a comprehensive package for those still interested in pursuing this treatment without Medicare coverage for $25,000. The cost may vary depending on your medical provider.
Some of the side effects of receiving HIFU treatment for prostate cancer include:
So, what are some alternatives to HIFU for those diagnosed with prostate cancer?
Removing the prostate surgically
Here are some additional treatment options from the American Cancer Society. You should confirm with your plan provider which treatments are covered under your Medicare plan.
If you are looking to receive treatment via HIFU, the reason you are seeking treatment is critical for determining affordability. The advancement of ultrasound technology has made it so treatment for these severe afflictions can come with significantly less bodily intrusion than traditional treatment methods. However, Medicare coverage only extends to those seeking treatment for tremors from Parkinson's disease.
Since Medicare once covered HIFU for prostate cancer, there might be an update concerning coverage in the future. We will update our blog accordingly, so stay in touch with Fair Square Medicare to stay abreast of any potential updates.
Before seeking treatment, remember to talk with your doctor. This content is for informational purposes only. If you have any questions about your Medicare coverage, call an expert today at 1-888-376-2028.
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