Health & Wellness
3 kinds of doctors: generalist, specialist and subspecialist
Read more
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.
| ID | Title | Last Review | Next Review | Description | Access |
|---|---|---|---|---|---|
| 07.001.008 | Endovascular Stent Grafts for Disorders of the Thoracic Aorta | Nov 17, 2023 | Jul 20, 2024 | Endovascular stent grafts using devices approved by u.s. food and drug administration (fda) may be... | View |
| 07.001.009 | Computer-Assisted Navigation for Orthopedic Procedures | May 17, 2024 | May 20, 2025 | Computer-assisted surgical navigation for orthopedic procedures is considered... | View |
| 07.001.010 | ARTROPLASTIA DE CADERA POR METODO MINIMAMENTE INVASIVO | May 16, 2016 | Policy Archived | La artroplastia minimamente invasiva para reemplazo de cadera o reemplazo de rodilla se considera para pago... | View |
| 07.001.011 | Transurethral Water Vapor Thermal Therapy for Benign Prostatic Hyperplasia | Jul 16, 2024 | Jul 20, 2025 | Transurethral water vapor thermal therapy is considered investigational as a treatment of benign prostatic... | View |
| 07.001.012 | Whole Gland Cryoablation of Prostate Cancer | Sep 08, 2023 | Sep 20, 2024 | Whole gland cryoablation of the prostate may be considered medically necessary as treatment of clinically... | View |
| 07.001.013 | Treatment of Varicose Veins/Venous Insufficiency | Jun 07, 2024 | Jun 20, 2025 | Saphenous veins great or small saphenous veins treatment of the great or small saphenous veins by... | View |
| 07.001.014 | Reduction Mammaplasty for Breast-Related Symptoms | Mar 14, 2024 | Mar 20, 2025 | Reduction mammaplasty may be considered medically necessary for the treatment of macromastia when... | View |
| 07.001.015 | Reconstructive Breast Surgery/Management of Breast Implants | Jul 10, 2024 | Jul 20, 2025 | Coverage eligibility of breast implants for the purposes of augmentation may depend on contract language.... | View |
| 07.001.016 | STEREOTACTIC, ULTRASOUND & MRI GUIDED BREAST BIOPSY (MIBB) | Nov 09, 2022 | Nov 09, 2023 | Triple-s will consider for payment stereotactic-guided non-palpable breast lesions that are seen only... | View |
| 07.001.017 | Ilizarov Bone-Lengthening Procedure | Feb 03, 2021 | Policy Archived | These services are considered for payment in the treatment of the following conditions: • treatment of... | View |
| 07.001.018 | Electrical Bone Growth Stimulation of the Appendicular Skeleton | May 17, 2024 | May 20, 2025 | Noninvasive electrical bone growth stimulation may be considered medically necessary for the treatment of... | View |
| 07.001.019 | CIRUGÍA DE PUENTES CORORIOS (CABG) | May 10, 2016 | Policy Archived | Al ocurrir una obstrucción de alguna(s) de la(s) arteria(s) principales del corazón, y si no ha ocurrido... | View |
| 07.001.021 | Endovascular Stent Grafts for Abdominal Aortic Aneurysms | Jun 10, 2024 | Jun 20, 2025 | The use of endoprostheses approved by the u.s. food and drug administration (fda) as a treatment of abdominal... | View |
| 07.001.022 | Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome | Jul 12, 2024 | Jul 20, 2025 | Palatopharyngoplasty (eg, uvulopalatopharyngoplasty, uvulopharyngoplasty, uvulopalatal flap, expansion... | View |
| 07.001.023 | Bariatric Surgery | May 12, 2024 | Mar 20, 2025 | Bariatric surgery in adults with class 3 obesity (bmi ≥40 kg/m2) the following bariatric surgery... | View |
| 07.001.024 | Transurethral Radiofrequency Needle Ablation of the Prostate | May 08, 2019 | Policy Archived | Transurethral radiofrequency needle ablation of the prostate (tuna) may be considered medically necessary as... | View |
| 07.001.025 | Sacral Nerve Neuromodulation/Stimulation | May 12, 2024 | May 20, 2025 | Urinary incontinence and nonobstructive retention criteria a a trial period of sacral nerve neuromodulation... | View |
| 07.001.026 | Bronchial Thermoplasty | Jul 10, 2024 | Jul 20, 2025 | Bronchial thermoplasty for the treatment of asthma is... | View |
| 07.001.027 | Transurethral destruction Of Prostate Tissue Using Microwave Thermotherapy | Jun 23, 2023 | Policy Archived | Transurethral destruction of prostate tissue as a treatment for benign prostatic hyperplasia by microwave... | View |
| 07.001.028 | Injectable Bulking Agents for the Treatment of Urinary and Fecal Incontinence | Nov 15, 2023 | Nov 20, 2024 | The use of carbon-coated spheres, calcium hydroxylapatite, polyacrylamide hydrogel, or polydimethylsiloxane... | View |
