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 |
|---|---|---|---|---|
| 07.001.023 | 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 2025 | 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 |
| 07.001.031 | Deep Brain Stimulation | May 2026 | Deep brain stimulation involves the stereotactic placement of an electrode into a central nervous system... | View |
| 07.001.032 | Phototherapeutic Keratectomy | Jun 2023 | Phototherapeutic keratectomy is considered for payment when used as an alternative to lamellar keratoplasty... | View |
| 07.001.033 | Otoplasty | Nov 2022 | Reconstructive surgery of the ear can be considered for injury, trauma or congenital conditions. congenital... | View |
| 07.001.034 | Litotripcia, onda de choque extracorporea (ESWL) | Jun 2023 | Shock wave lithotripsy — extracorporeal shock wave lithotripsy (eswl)remains one of the most commonly... | View |
| 07.001.037 | Bone Morphogenetic Protein | May 2026 | Two recombinant human bone morphogenetic proteins (rhbmps) have been extensively studied: recombinant human... | View |
| 07.001.039 | Meniscal Allografts And Other Meniscal Implants | May 2026 | Meniscal allografts and other meniscal implants (eg, collagen) are intended to improve symptoms and reduce... | View |
| 07.001.040 | Cirugia reconstructiva post cirugia baríatrica | Jun 2023 | Morbid obesity is defined as an increase in body weight above an optimal level resulting in significant... | View |
| 07.001.041 | Cochlear Implant | Mar 2026 | A cochlear implant is a device for treatment of severe-to-profound hearing loss in individuals who only... | View |
| 07.001.042 | Percutaneous Intradiscal Electrothermal Annuloplasty, Radiofrequency Annuloplasty, And Biacuplasty | May 2026 | Electrothermal intradiscal annuloplasty therapies use radiofrequency energy sources to treat discogenic low... | View |
| 07.001.043 | Autografts And Allografts In The Treatment Of Focal Articular Cartilage Lesions | May 2026 | Osteochondral grafts are used to repair full-thickness chondral defects involving a joint. in the case of... | View |
| 07.001.044 | Implantable Bone-Conduction And Bone-Anchored Hearing Aids | Mar 2025 | Sensorineural, conductive, and mixed hearing loss may be treated with various devices, including conventional... | View |
| 07.001.045 | Surgical Ventricular Restoration | Mar 2026 | Surgical ventricular restoration is designed to restore or remodel the left ventricle to its normal,... | View |