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 |
|---|---|---|---|---|
| 07.001.117 | Minimally Invasive Ablation Procedures for Morton and Other Peripheral Neuromas | Jul 2025 | Morton neuroma is a common and painful compression0001 neuropathy of the dorsal foot that is also referred to... | View |
| 07.001.118 | Percutaneous Electrical Nerve Stimulation And Pecutaneous Neuromodulation Therapy | Apr 2026 | Percutaneous electrical nerve stimulation (pens), percutaneous neuromodulation therapy (pnt), and restorative... | View |
| 07.001.119 | Surgical Treatments For Breast Cancer-Related Lymphedema | Oct 2025 | Surgery and radiotherapy for breast cancer can lead to lymphedema and are some of the most common causes of... | View |
| 07.001.120 | Facet Arthroplasty | May 2026 | Facet arthroplasty refers to the implantation of a spinal prosthesis to restore posterior element structure... | View |
| 07.001.121 | Absorbable Nasal Implant For Treatment Of Nasal Valve Collapse | Nov 2025 | Nasal valve collapse (nvc) is a readily identifiable cause of nasal obstruction. specifically, the internal... | View |
| 07.001.122 | Adipose-Derived Stem Cells In Autologous Fat Grafting To The Breast | Feb 2026 | Following a mastectomy, patients often experience pain and irradiated skin; as an adjunct to reconstructive... | View |
| 07.001.123 | Hydrogel Spacer use During Radiotherapy for Prostate Cancer | Sep 2025 | For low- or intermediate-risk prostate cancer, radiation therapy is an option. because the rectum lies in... | View |
| 07.001.124 | Semi-Implantable And Fully Implantable Middle Ear Hearing Aids | Mar 2026 | Moderate-to-severe sensorineural hearing loss is often treated with external acoustic hearing aids, while... | View |
| 07.001.125 | Surgical Deactivation Of Headache Trigger Sites | Mar 2026 | Migraine is a common headache disorder that is treated using various medications, which can be taken at the... | View |
| 07.001.126 | Handheld Radiofrequency Spectroscopy For Intraoperative Assessment Of Surgical Margins During Breast-Conserving Surgery | Mar 2026 | As part of the treatment of localized breast cancer, breast-conserving surgery is optimally achieved by... | View |
| 07.001.127 | Surgery For Groin Pain In Athletes | Mar 2026 | Sports-related groin pain, commonly known as athletic pubalgia or sports hernia, is characterized by... | View |
| 07.001.128 | Balloon Dilation Of The Eustachian Tube | Mar 2026 | Eustachian tube dysfunction (etd) occurs when the functional valve of the eustachian tube fails to open... | View |
| 07.001.129 | Synthetic Cartilage Implants For Joint Pain | Aug 2025 | Articular cartilage damage, either from a focal lesion or diffuse osteoarthritis (oa), can result in... | View |
| 07.001.132 | Rhinoplasty | Nov 2021 | Rhinoplasty rhinoplasty is a procedure to correct congenital anatomical deformities acquired in the nostrils.... | View |
| 07.001.133 | Radiofrequency Coblation Tenotomy For Musculoskeletal Conditions | Jan 2026 | Radiofrequency (rf) coblation is being evaluated for the treatment of plantar fasciitis, lateral... | View |
| 07.001.134 | Steroid-Eluting Sinus Stents | Mar 2026 | Steroid-eluting sinus stents are devices used postoperatively following endoscopic sinus surgery (ess) or for... | View |
| 07.001.139 | Peripheral Subcutaneous Field Stimulation | May 2026 | ... | View |
| 07.001.143 | Responsive Neurostimulation For The Treatment Of Refractory Focal Epilepsy | May 2026 | Approximately one-third of individuals with epilepsy do not respond to typical first-line therapy with... | View |
| 07.001.146 | Discectomy | Feb 2026 | ... | View |
| 07.001.148 | Endovascular Therapies For Extracranial Vertebral Artery Disease | Jul 2024 | Vertebral artery diseases, including atherosclerotic stenosis, dissections, and aneurysms, can lead to... | View |