Medical Policies
Medical policies are documents that define the plan coverage for technologies, procedures and treatments. The statements of medical necessity in the policies, about whether a technology, procedure, treatment, supply, equipment, drug or other service improves the health outcome of the population for which said technology or treatment was designed are based on scientific evidence, clinical studies and professional opinions from our providers and recognized medical organizations.
Each document displayed on this website is provided for informational purposes only and is not an authorization, explanation of benefits, or contract. Receiving benefits is subject to satisfaction of all terms and conditions of coverage. Medical technology is constantly changing, and we reserve the right to periodically review and update our policies.
Medical Policies table
| ID | Title | Review | Description | Access |
|---|---|---|---|---|
| 07.001.008 | Endovascular Stent Grafts For Disorders Of The Thoracic Aorta | Jan 2026 | Thoracic endovascular aortic repair (tevar) involves the percutaneous placement of a stent graft in the... | View |
| 07.001.009 | Computer-Assisted Navigation For Orthopedic Procedure | Jun 2026 | Computer-assisted navigation in orthopedic procedures describes the use of computer-enabled tracking systems... | View |
| 07.001.011 | Transurethral Water Vapor Thermal Therapy For Benign Prostatic Hyperplasia | Aug 2026 | Transurethral water vapor thermal therapy and transurethral waterjet ablation (aquablation) have been... | View |
| 07.001.012 | Whole Gland Cryoablation Of Prostate Cancer | Oct 2024 | Cryoablation, also known as cryotherapy or cryosurgery, is a procedure that attacks cancer cells using... | View |
| 07.001.013 | Treatment Of Varicose Veins/Venous Insufficiency | Jun 2026 | A variety of treatment modalities are available to treat varicose veins/venous insufficiency, including... | View |
| 07.001.014 | Reduction Mammaplasty For Breast-Related Symptoms | Mar 2026 | Macromastia, or gigantomastia, is a condition that describes breast hyperplasia or hypertrophy. macromastia... | View |
| 07.001.015 | Reconstructive Breast Surgery/Management Of Breast Implants After Mastectomy | Jul 2026 | Reconstructive breast surgery is defined as a surgical procedure that is designed to restore the normal... | View |
| 07.001.016 | STEREOTACTIC, ULTRASOUND & MRI GUIDED BREAST BIOPSY (MIBB) | Aug 2026 | Minimally invasive breast biopsy (mibb) is a breast biopsy that is done with a needle to obtain a diagnosis... | View |
| 07.001.017 | Ilizarov Bone-Lengthening Procedure | Feb 2021 | The ilizarov bone-lengthening procedure uses a circular external fixator device that attaches to the bone via... | View |
| 07.001.018 | Electrical Bone Growth Stimulation Of The Appendicular Skeleton | May 2026 | In the appendicular skeleton, electrical stimulation with either implantable electrodes or noninvasive... | View |
| 07.001.021 | Endovascular Stent Grafts For Abdominal Aortic Aneurysms | Jun 2026 | Endovascular stent grafts can be used as minimally invasive alternatives to open surgical repair for... | View |
| 07.001.022 | Surgical Treatment Of Snoring And Obstructive Sleep Apnea Syndrome | Jan 2026 | Obstructive sleep apnea (osa) syndrome is characterized by repetitive episodes of upper airway obstruction... | View |
| 07.001.023 | Bariatric Surgery | Jan 2026 | Complete guidelines available at https://www.aace.com/publications/guidelines. endocr pract. jul 2016; 22(7):... | View |
| 07.001.024 | Transurethral Radiofrequency Needle Ablation Of The Prostate | May 2019 | Transurethral radiofrequency needle ablation of the prostate (also known as tuna or rfna) of the prostate has... | View |
| 07.001.025 | Sacral Nerve Neuromodulation/Stimulation | May 2026 | Sacral nerve neuromodulation, also known as sacral nerve stimulation, involves the implantation of a... | View |
| 07.001.026 | Bronchial Thermoplasty | Jul 2026 | Bronchial thermoplasty is a potential treatment option for individuals with severe persistent asthma. it... | View |
| 07.001.027 | Destrucción transuretral de tejido prostático mediante termoterapia de microonda | Jun 2023 | Transurethral destruction of prostate tissue by microwave therapy is an alternative to transurethral... | View |
| 07.001.028 | Injectable Bulking Agents For The Treatment Of Urinary And Fecal Incontinence | Apr 2026 | Bulking agents are injectable substances used to increase tissue bulk. they can be injected periurethrally to... | View |
| 07.001.029 | Spinal Cord And Dorsal Root Ganglion Stimulation | May 2026 | Spinal cord stimulation delivers low-voltage electrical stimulation to the dorsal columns of the spinal cord... | View |
| 07.001.030 | Vagus Nerve Stimulation | Mar 2026 | Stimulation of the vagus nerve can be performed using a pulsed electrical stimulator implanted within the... | View |