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 |
|---|---|---|---|---|
| 01.001.023 | Hemophilia Antihemophilic Factor | Jul 2024 | The hemophilias are a group of related bleeding disorders that most commonly are inherited. inherited... | View |
| 01.001.024 | Automated Insulin Delivery Systems | Apr 2026 | Automated insulin delivery systems, also known as artificial pancreas device systems, link a glucose monitor... | View |
| 01.001.025 | Tumor Treating Fields Therapy | Aug 2025 | Tumor treating fields (ttf) therapy is a noninvasive technology intended to treat glioblastoma, malignant... | View |
| 01.001.026 | Cooling Devices Used In The Outpatient Setting | Apr 2026 | Cooling devices use chilled water to decrease the local temperature of tissue. there are a variety of cooling... | View |
| 01.001.027 | Interferential Current Stimulation | Jul 2025 | Interferential current stimulation (ifs) is a type of electrical stimulation used to reduce pain. the... | View |
| 01.001.028 | Postsurgical Home Use Of Limb Compression Devices For Venous Thromboembolism Prophylaxis | Apr 2026 | Antithrombotic prophylaxis is recommended for surgical individuals at moderate-to-high risk of postoperative... | View |
| 01.001.029 | Pelvic Floor Stimulation As A Treatment Of Urinary Incontinence | Sep 2025 | Pelvic floor stimulation is proposed as a nonsurgical treatment option for women and men with urinary or... | View |
| 01.002.002 | Nutrición enteral en el hogar | Sep 2016 | ... | View |
| 01.002.003 | Nutrición parenteral en el hogar | Nov 2017 | ... | View |
| 01.002.004 | Negative Pressure Wound Therapy in the Outpatient Setting | Sep 2025 | Negative pressure wound therapy (npwt) involves the use of negative pressure or suction device to aspirate... | View |
| 01.002.005 | Materials Or Surgical Medical Supplies | Nov 2020 | Medical supplies that, due to their diagnostic or therapeutic characteristics, are essential for the... | View |
| 01.002.006 | Digital Health Technologies: Therapeutic Applications | Nov 2025 | Digital health technologies is a broad term that includes categories such as mobile health, health... | View |
| 01.003.004 | Powered Exoskeleton For Ambulation In Patients With Lower-Limb Disabilities | Apr 2026 | The goal of the powered exoskeleton is to enable people who do not have volitional movement of their lower... | View |
| 01.003.005 | Patient-Controlled End Of Range Motion Stretching Devices | Apr 2026 | Patient-controlled stretching devices are used at home to increase range of motion in individuals who have... | View |
| 01.004.001 | Protesis e Implantes | Nov 2016 | ... | View |
| 01.005.002 | Lower Limb Prosthesis | Nov 2021 | A prosthesis is an artificial substitute that replaces all or part of an organ of the body, or replaces all... | View |
| 02.001.001 | Extracorporeal Shock Wave Treatment For Plantar Fasciitis And Other Musculoskeletal Conditions | Jul 2025 | Extracorporeal shock wave therapy (eswt) is a noninvasive method used to treat pain with shock or sound waves... | View |
| 02.001.002 | Immunotherapy For Allergies | Jul 2025 | Immunotherapy in allergies requires regular injections of an allergen for months in order to reduce symptoms.... | View |
| 02.001.004 | Optical Diagnostic Devices For Evaluating Skin Lesions Suspected Of Malignancy | Oct 2025 | There is interest in noninvasive devices that will improve the diagnosis of malignant skin lesions. one... | View |
| 02.001.005 | Impedancia eléctrica en el barrido del seno | May 2016 | ... | View |