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
09.003.011 Keratoprosthesis Apr 2026 A keratoprosthesis, consisting of a central optic held in a cylindrical frame, is an artificial cornea... View
09.003.012 Orthoptic Training For The Treatment Of Vision Or Learning May 2024 Orthoptic training refers to techniques designed to correct accommodative and convergence insufficiency (or... View
09.003.013 Retinal Telescreening For Diabetic Retinopathy May 2025 Retinopathy telescreening and risk assessment with digital imaging systems are proposed as an alternative to... View
09.003.014 Corneal Collagen Cross-Linking Aug 2026 Corneal collagen cross-linking is a photochemical procedure approved by the u.s. food and drug administration... View
09.003.026 Viscocanalostomy And Canaloplasty Apr 2026 Glaucoma surgery is intended to reduce intraocular pressure when the target intraocular pressure cannot be... View
09.003.030 Ocriplasmin For Symptomatic Vitreomacular Adhesion May 2024 Ocriplasmin is a recombinant truncated form of human plasmin, a proteolytic enzyme that breaks down protein... View
09.003.031 Ophthalmologic Techniques That Evaluate The Posterior Segment For Glaucoma Apr 2026 Several techniques have been developed to measure the thickness of the optic nerve and retinal nerve fiber... View
09.003.032 Fundus Photography and Extended Ophthalmoscopy Aug 2026 Fundus photography fundus photography is the practice of using a retinal camera to record anomalies in the... View
09.003.033 Sensorimotor Examination Mar 2026 Sensorimotor examination is used to evaluate ocular motility, binocular vision, and alignment abnormalities,... View
09.003.034 Serial Tonometry Aug 2026 Serial tonometry is a diagnostic procedure that involves a minimum of three tonometry measurements spread... View
10.001.005 Cirugía intentada Aug 2017 ... View
10.001.010 Ambulancias y servicios de transportación médica May 2016 ... View
10.001.013 Clinical Trials Nov 2018 A clinical trial is a research study that is used in the medical field to find new avenues to improve health.... View
10.001.014 TELEMEDICINE Oct 2026 Telemedicine is the remote exchange of medical information through secure electronic communication to support... View
10.001.026 Glucometers And Supplies Nov 2018 A blood glucose monitor (glucometer) is a portable, battery-operated device used to determine the blood... View
10.002.001 Chiropractic Services Jun 2026 The primary mode of chiropractic treatment is manual or instrument-assisted manipulation or adjustment.... View
10.002.006 Osteopathy Doctors’ Services Jun 2026 The osteopath is a health professional whose studies are equivalent to a doctorate. his training emphasizes... View
10.002.010 Acupuncture Apr 2022 Acupuncture is the practice of piercing the skin with needles at specific body sites to induce anesthesia, to... View
11.001.001 Autologous Blood Transfusion (Cell Saver) Sep 2024 Surgical blood conservation techniques are used to reduce patient exposure to allogeneic blood during and... View
11.001.003 Anti-Ccp Testing For Rheumatiod Arthritis May 2023 Extensive evidence has established that anti-ccp has a moderately high sensitivity, a high specificity, and... View