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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 |
|---|---|---|---|---|---|
| 10.001.013 | Clinical Trials | Nov 14, 2018 | Policy Archived | 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 24, 2024 | Oct 20, 2025 | Telemedicine is defined as the exchange of medical information between the sites through electronic... | View |
| 10.001.026 | Glucometers And Supplies | Nov 14, 2018 | Policy Archived | A blood glucose monitor (glucometer) is a portable, battery-operated device used to determine the blood... | View |
| 10.002.001 | Chiropractic Services | Sep 11, 2024 | Policy Archived | The primary mode of chiropractic treatment is manual or instrument-assisted manipulation or adjustment.... | View |
| 10.002.002 | Servicios de Sicólogos Clínicos | Dec 29, 2017 | Policy Archived | ... | View |
| 10.002.003 | Servicios de Optometría | Aug 22, 2017 | Policy Archived | ... | View |
| 10.002.006 | Osteopathy Doctors’ Services | Jul 13, 2022 | Policy Archived | The osteopath is a health professional whose studies are equivalent to a doctorate. his training emphasizes... | View |
| 10.002.007 | Servicios de Trabajador Social Clínico | Nov 26, 2024 | Policy Archived | A social worker is a person trained to help people manage, prevent or cope with everyday problems. they are... | View |
| 10.002.009 | Servicios de Audiología | May 11, 2016 | Policy Archived | ... | View |
| 10.002.010 | Acupuncture | Apr 20, 2022 | Policy Archived | 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 10, 2024 | Policy Archived | 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 26, 2023 | Policy Archived | Extensive evidence has established that anti-ccp has a moderately high sensitivity, a high specificity, and... | View |
| 11.001.004 | Marcadores de tumor sericos para cáncer de mama y gastrointestinal | Sep 21, 2016 | Policy Archived | ... | View |
| 11.001.005 | In Vitro Chemoresistance And Chemosensitivity Assays | Sep 09, 2021 | Policy Archived | In vitro chemoresistance and chemosensitivity assays have been developed to provide information about the... | View |
| 11.001.006 | Prueba de aliento de urea en el diagnóstico Helicobacter Pylori | Feb 10, 2025 | Policy Archived | Several invasive and non-invasive tests are available for the detection of helicobacter pylori infection in... | View |
| 11.001.007 | Identification Of Microorganisms Using Nucleic Acid Probes | Jul 16, 2024 | Jul 20, 2025 | Nucleic acid probes are available for the identification of a wide variety of microorganisms. nucleic acid... | View |
| 11.001.009 | Noninvasine Techniques For The Evaluation And Monitoring Of Patients With Chronic Liver Disease | Dec 12, 2024 | Dec 20, 2025 | Noninvasive techniques to monitor liver fibrosis are being investigated as alternatives to liver biopsy in... | View |
| 11.001.010 | Alfa-fetoproteina en la deteccion de cancer hepatocelular | May 12, 2016 | Policy Archived | ... | View |
| 11.001.011 | Serum Biomarker Human Epididymis Protein 4 | Jan 21, 2025 | Jan 20, 2026 | Human epididymis protein 4 (he4) is a novel biomarker that has been cleared by the u.s. food and drug... | View |
| 11.001.012 | Jak2 And Mpl, Testing For Myeloproliferative Neoplasms | Sep 23, 2024 | Sep 20, 2025 | Somatic (acquired) genetic variants in jak2, mpl, and calr genes have been implicated as the underlying... | View |
