Dr. Michael Lazar performing first HIFU surgery on the West Coast at San Francisco Surgery Center –>
Cigna, a a global health insurance service company based in the US, announced earlier this year that patients in the United States who have localized radio-recurrent prostate cancer are potentially eligible for insurance coverage for HIFU treatment.
In other words, if a man was diagnosed with localized prostate cancer and then had radiation therapy then had the cancer return to the prostate and was diagnosed with localized recurrent prostate cancer, he may be eligible for coverage for having HIFU as a salvage option. It is important to note that coverage is policy specific so it may vary depending on the policy. More information is available from Cigna in the medical coverage policy document for HIFU which was updated January 15, 2018.
Specifically, the document states that coverage of HIFU as a salvage therapy after failure of radiotherapy will be considered for patients who have completed a repeat transrectal ultrasound-guided biopsy and who are suspected of having local recurrence of disease.
This is yet another substantial development for HIFU as a treatment for localized prostate cancer as CIGNA is one of the five largest payors in the U.S., covering 15.9 million lives. In July 2017, a Medicare code was issued by the Centers for Medicare and Medicaid Services that may help some patients cover part of the cost of the HIFU procedure. Additional information about reimbursement may be found at https://www.hifuprostateservices.com/reimbursement.