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 |
|---|---|---|---|---|
| 07.001.058 | Artificial Intervertebral Disc: Cervical Spine | May 2026 | Several prosthetic devices are currently available for cervical disc arthroplasty. cervical disc arthroplasty... | View |
| 07.001.059 | Reemplazo de tobillo | May 2016 | ... | View |
| 07.001.060 | Radiofrequency Ablation Of Primary Or Metastatic Liver Tumors | Aug 2026 | Radiofrequency ablation (rfa) is a procedure in which a probe is inserted into the center of a tumor and... | View |
| 07.001.061 | Wireless Pressure Sensors In Endovascular Aneurysm Repair | May 2019 | Wireless sensors implanted in an aortic aneurysm sac after endovascular repair are being investigated to... | View |
| 07.001.064 | Transanal Endoscopic Microsurgery | Oct 2026 | Transanal endoscopic microsurgery (tem) is a minimally invasive approach for local excision of rectal lesions... | View |
| 07.001.065 | Artificial Intervertebral Disc: Lumbar Spine | Mar 2026 | Total disc replacement, using an artificial intervertebral disc designed for the lumbar spine, is proposed as... | View |
| 07.001.066 | Risk-Reducing Mastectomy | Oct 2026 | Risk-reducing mastectomy is defined as the removal of the breast in the absence of malignant disease to... | View |
| 07.001.067 | Nerve Graft With Radical Prostatectomy | Jun 2025 | Nerve grafting at the time of radical prostatectomy, most commonly using the sural nerve, has been proposed... | View |
| 07.001.071 | Radiofrequency Ablation Of Miscellaneous Solid Tumors Excluding Liver Tumors | Aug 2026 | In radiofrequency ablation (rfa), a probe is inserted into the center of a tumor; then, prong-shaped,... | View |
| 07.001.072 | Axial Lumbosacral Interbody Fusion | May 2026 | Axial lumbosacral interbody fusion (also called presacral, transsacral, or paracoccygeal interbody fusion) is... | View |
| 07.001.073 | Interspinous And Interlaminar Stabilization/Distraction Devices (Spacers) | May 2026 | Interspinous and interlaminar implants (spacers) stabilize or distract the adjacent lamina and/or spinous... | View |
| 07.001.074 | Facet Joint Denervation | Dec 2025 | Facet denervation is used to treat neck and back pain originating in facet joints with degenerative changes.... | View |
| 07.001.076 | Saturation Biopsy For Diagnosis, Staging, And Management Of Prostate Cancer | Aug 2026 | Saturation biopsy of the prostate, in which more cores are obtained than by standard biopsy protocol, has... | View |
| 07.001.077 | Plugs For Anal Fistula Repair | Oct 2026 | Anal fistula plugs (afps) are biosynthetic devices used to promote healing and prevent the recurrence of anal... | View |
| 07.001.079 | Occipital Nerve Stimulation | May 2026 | Occipital nerve stimulation delivers a small electrical charge to the occipital nerve intended to prevent... | View |
| 07.001.080 | Surgical Treatment Of Femoroacetabular Impingement | Jun 2026 | Femoroacetabular impingement results from localized compression within the joint as a result of an anatomic... | View |
| 07.001.081 | Laser Treatment Of Wine Stains | Mar 2026 | Destruction of cutaneous vascular proliferative lesions (cvpls) involves the use of laser or other... | View |
| 07.001.082 | Bronchial Valves | Jul 2026 | Bronchial valves are synthetic devices deployed with bronchoscopy into ventilatory airways of the lung to... | View |
| 07.001.083 | Surgery Of Paranasal Sinuses Guided By Images | Nov 2020 | Surgery guided by images is a system of three-dimensional mapping that combines computerized tomography and... | View |
| 07.001.085 | Autologous Fat Grafting To The Breast And Adipose-Derived Stem Cells | Jun 2066 | Autologous fat grafting to the breast has been used as an adjunct to reconstructive breast surgery, for... | View |