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 |
|---|---|---|---|---|
| 07.001.047 | Cirugía robótica | May 2016 | ... | View |
| 07.001.048 | Intraoperative Neurophysiologic Monitoring | May 2026 | Intraoperative neurophysiologic monitoring describes a variety of procedures used to monitor the integrity of... | View |
| 07.001.049 | Percutaneous Nephrostolithotomy And Lithetripsy For Kidney Stones | Sep 2019 | Percutaneous nephrostolithotomy (pcn) is an invasive procedure for removing upper urinary tract stones by... | View |
| 07.001.050 | Implantable Cardioverter Defibrillators | Jun 2025 | An implantable cardioverter defibrillator (icd) is a device designed to monitor a patient's heart rate,... | View |
| 07.001.051 | Balloon Ostial Dilation For Treatment Of Chronic Rhinosinusitis | Mar 2026 | Balloon ostial dilation (bod, also known as balloon sinuplasty) is proposed as an alternative to functional... | View |
| 07.001.052 | Tibial Nerve Stimulation | Feb 2026 | Percutaneous tibial nerve stimulation (ptns; also known as posterior tibial nerve stimulation) is an... | View |
| 07.001.053 | Auditory Brainstem Implant | Mar 2026 | An auditory brainstem implant (abi) is designed to restore some hearing in people with neurofibromatosis type... | View |
| 07.001.054 | Periureteral Bulking Agents As A Treatment Of Vesicoureteral Reflux | Sep 2025 | Most commonly seen in children, vesicoureteral reflux (vur) is the retrograde flow of urine from the bladder... | View |
| 07.001.055 | Thermal Capsulorrhaphy As A Treatment Of Joint Instability | Apr 2019 | Thermal capsulorrhaphy uses thermal energy to restructure collagen in the capsule or ligaments to reduce the... | View |
| 07.001.056 | Transmyocardial Revascularization | Mar 2025 | Transmyocardial revascularization (tmr), also known as transmyocardial laser revascularization, is a surgical... | View |
| 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 2025 | 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 | Dec 2025 | 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 2025 | 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 |
| 07.001.069 | Isolated Limb Perfusion/Infision for Malignant Melanoma | Apr 2019 | Isolated limb perfusion (ilp) when used as a therapeutic treatment of local recurrence of nonresectable... | View |
| 07.001.070 | Tonsilectomia Asistida por Láser | May 2016 | ... | View |