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
09.003.003 Fotocoagulación del drusen macular Sep 2016 ... View
09.003.004 Intraocular Radiotherapy For Age-Related Macular Degeneration Apr 2026 Intraocular radiation, including brachytherapy, proton beam therapy, and stereotactic radiotherapy, are being... View
09.003.005 Intravitreal And Punctum Corticosteroid Implants May 2026 An intravitreal implant is a drug delivery system, injected or surgically implanted in the vitreous of the... View
09.003.006 Intravitreal Angiogenesis Inhibitors For Retinal Vascular Conditions Feb 2026 ... View
09.003.007 Contact Lenses For The Pediatric Population Nov 2021 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 Feb 2026 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 2026 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 2025 Glaucoma surgery is intended to reduce intraocular pressure (iop) when the target iop cannot be reached using... View
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 Mar 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 Jan 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
10.001.001 Procedimientos multiples, secundarios e incidentales Aug 2017 ... View
10.001.003 Procedimeintos quirúrgicos en oficinas con uso de los modificadores OS y OB Jun 2016 ... View
10.001.004 Cirugía ambulatoria Aug 2017 ... View