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 |
|---|---|---|---|---|
| 07.001.086 | Image-Guided Minimally Invasive Decompression For Spinal Stenosis | May 2026 | Image-guided minimally invasive decompression describes a percutaneous procedure for decompression of the... | View |
| 07.001.088 | Lung Volume Reduction Surgery For Severe Emphysema | Jul 2026 | Description – intro lung volume reduction surgery (lvrs) is proposed as a treatment option for patients... | View |
| 07.001.089 | Septoplasty | Nov 2021 | Septoplasty nasal septoplasty is a procedure to correct anatomical deformity or deviation of the nasal... | View |
| 07.001.090 | Microwave Tumor Ablation | Jun 2026 | Microwave ablation (mwa) is a technique to destroy tumors and soft tissue using microwave energy to create... | View |
| 07.001.091 | Electrical Stimulation Of The Spine As An Adjunct To Spinal Fusion Procedures | Jun 2026 | Both invasive and noninvasive electrical bone growth stimulators have been investigated as an adjunct to... | View |
| 07.001.092 | Interspinous Fixation (Fusion) Devices | May 2026 | Interspinous fixation (fusion) devices are being developed to aid in the stabilization of the spine. they are... | View |
| 07.001.094 | Magnetic Esophageal Sphincter Augmentation To Treat Gastroespphageal Reflux Disease | Oct 2026 | A laparoscopically implanted ring composed of interlinked titanium beads with magnetic cores has been... | View |
| 07.001.095 | Coblation Assisted Tonsilectomy | Nov 2021 | Standard electro-surgical instruments and lasers use thermal energy. other methods to break down tissues have... | View |
| 07.001.096 | Magnetic Resonance-Guided Focused Ultrasound | Aug 2026 | An integrated system providing magnetic resonance-guided focused ultrasound (mrgfus) treatment is proposed as... | View |
| 07.001.097 | Transcatheter Closure Of Patent Ductus Arteriosus | Jun 2019 | The ductus arteriosus is the vascular remnant of the left sixth aortic arch, connecting the main pulmonary... | View |
| 07.001.098 | Debridment | Jun 2026 | A wound is a disruption of the normal structure and function of the skin and skin architecture. an acute... | View |
| 07.001.099 | Hip Resurfacing | May 2026 | Hip resurfacing is an alternative to total hip arthroplasty (also known as hip replacement) for patients with... | View |
| 07.001.100 | Cryosurgical Ablation Of Primary Or Metastatic Liver Tumors | Oct 2026 | Cryosurgical ablation (csa), also known as cryoablation, involves the freezing of target tissues, often by... | View |
| 07.001.101 | Subtalar Arthroereisis | May 2026 | Arthroereisis is a surgical procedure that purposely limits movement across a joint. subtalar arthroereisis... | View |
| 07.001.102 | Lumbar Spinal Fusion | Oct 2026 | Lumbar spinal fusion (arthrodesis) is a surgical technique that involves fusing 2 or more lumbar vertebrae... | View |
| 07.001.103 | Transcatheter Aortic Valve Implantation For Aortic Stenosis | Sep 2026 | Aortic stenosis is narrowing of the aortic valve opening, resulting in obstruction of blood flow from the... | View |
| 07.001.104 | Transcatheter Pulmonary Valve Implantation | Jul 2026 | Transcatheter pulmonary valve implantation (tpvi) is a less invasive alternative to open surgical pulmonary... | View |
| 07.001.105 | Electromagnetic Navigational Bronchoscopy | Jul 2026 | Electromagnetic navigation bronchoscopy (enb) is intended to enhance standard bronchoscopy by providing a... | View |
| 07.001.107 | Surgical Treatment Of Bilateral Gynecomastia | Mar 2026 | Gynecomastia, a benign proliferation of the glandular tissue of the male breast, is caused by an increase in... | View |
| 07.001.108 | Laminectomy | Jul 2026 | Laminectomy is a surgical procedure in which a portion of the vertebra (the lamina) is removed to decompress... | View |