Home & Lifestyle
5 habits to add years to your life
Read more
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.
| ID | Title | Last Review | Next Review | Description | Access |
|---|---|---|---|---|---|
| 09.003.007 | Contact Lenses For The Pediatric Population | Nov 10, 2021 | Policy Archived | It is estimated that 40.9 million people over the age of 18 in the united states (one in six adults) wear... | View |
| 09.003.008 | Intravitreal Angiogenesis Inhibitors For Choroidal Vascular Conditions | Mar 29, 2019 | Policy Archived | Angiogenesis inhibitors (eg, ranibizumab, bevacizumab, pegaptanib, aflibercept) are being evaluated for the... | View |
| 09.003.009 | Eyelid Thermal Pulsation For The Treatment Of Dry Eye Syndrome | Apr 10, 2024 | Apr 20, 2025 | Thermal pulsation is a treatment option for meibomian gland dysfunction. meibomian gland dysfunction is... | View |
| 09.003.010 | Aqueous Shunts And Stents For Glaucoma | Dec 20, 2024 | Dec 20, 2025 | Glaucoma surgery is intended to reduce intraocular pressure (iop) when the target iop cannot be reached using... | View |
| 09.003.011 | Keratoprosthesis | Apr 10, 2024 | Apr 20, 2025 | 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 12, 2024 | Policy Archived | Orthoptic training refers to techniques designed to correct accommodative and convergence insufficiency (or... | View |
| 09.003.013 | Retinal Telescreening For Diabetic Retinopathy | Apr 15, 2024 | Apr 20, 2025 | Retinopathy telescreening and risk assessment with digital imaging systems are proposed as an alternative to... | View |
| 09.003.014 | Corneal Collagen Cross-Linking | Apr 17, 2024 | Apr 20, 2025 | 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 15, 2024 | Apr 20, 2025 | 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 20, 2024 | Policy Archived | 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 15, 2024 | Apr 20, 2025 | Several techniques have been developed to measure the thickness of the optic nerve and retinal nerve fiber... | View |
| 10.001.001 | Procedimientos multiples, secundarios e incidentales | Aug 22, 2017 | Policy Archived | ... | View |
| 10.001.003 | Procedimeintos quirúrgicos en oficinas con uso de los modificadores OS y OB | Jun 30, 2016 | Policy Archived | ... | View |
| 10.001.004 | Cirugía ambulatoria | Aug 22, 2017 | Policy Archived | ... | View |
| 10.001.005 | Cirugía intentada | Aug 22, 2017 | Policy Archived | ... | View |
| 10.001.006 | Procedimientos independientes | Aug 22, 2017 | Policy Archived | ... | View |
| 10.001.007 | Códigos U | May 01, 2015 | Policy Archived | ... | View |
| 10.001.008 | Procedimiento con informe (by report) | May 11, 2016 | Policy Archived | ... | View |
| 10.001.009 | Procedimientos con asteriscos en la tarifa | Aug 22, 2017 | Policy Archived | ... | View |
| 10.001.010 | Ambulancias y servicios de transportación médica | May 11, 2016 | Policy Archived | ... | View |
