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 |
|---|---|---|---|---|---|
| 01.005.002 | Lower Limb Prosthesis | Nov 10, 2021 | Nov 10, 2022 | A prosthesis is an artificial substitute that replaces all or part of an organ of the body, or replaces all... | View |
| 02.001.001 | Extracorporeal Shock Wave Treatment For Plantar Fasciitis And Other Musculoskeletal Conditions | Jul 15, 2024 | Jul 20, 2025 | Extracorporeal shock wave therapy (eswt) is a noninvasive method used to treat pain with shock or sound waves... | View |
| 02.001.002 | Immunotherapy For Allergies | Jul 08, 2022 | Policy Archived | Immunotherapy in allergies requires regular injections of an allergen for months in order to reduce symptoms.... | View |
| 02.001.004 | Optical Diagnostic Devices For Evaluating Skin Lesions Suspected Of Malignancy | Oct 22, 2020 | Policy Archived | There is interest in noninvasive devices that will improve the diagnosis of malignant skin lesions. one... | View |
| 02.001.005 | Impedancia eléctrica en el barrido del seno | Dec 31, 1969 | NA | Na... | View |
| 02.001.006 | Prolotherapy | Dec 09, 2024 | Dec 20, 2025 | Prolotherapy describes a procedure intended for healing and strengthening ligaments and tendons by injecting... | View |
| 02.001.007 | Antibióticos en aerosol como tratamiento de la sinusitis crónica | Dec 31, 1969 | NA | Na... | View |
| 02.001.008 | Monitoreo del flujo sanguíneo cerebral regional usando una sonda térmica | Dec 31, 1969 | NA | Na... | View |
| 02.001.009 | Suspensión de la vegija urinaria usando radiofrecuencia transvaginal para incont | Dec 31, 1969 | NA | Na... | View |
| 02.001.010 | Nonpharmacologic Treatment Of Rosacea | Jan 20, 2025 | Jan 20, 2026 | Rosacea is a chronic, inflammatory skin condition without a known cure; the goal of treatment is symptom... | View |
| 02.001.011 | Hyperbaric Oxygen Therapy | Jul 19, 2023 | Policy Archived | Hyperbaric oxygen therapy (hbot) involves breathing 100% oxygen at pressures between 1.5 and 3.0 atmospheres.... | View |
| 02.001.012 | Continuous Or Intermittent Monitoring Of Glucose In Interstitial Fluid | Aug 05, 2024 | Aug 20, 2025 | Tight glucose control in patients with diabetes has been associated with improved health outcomes. several... | View |
| 02.001.013 | Stent prostático temporero | Dec 31, 1969 | NA | Na... | View |
| 02.001.014 | Vendaje de calor radiante para el tratamiento de heridas | Dec 31, 1969 | NA | Na... | View |
| 02.001.015 | Paraspinal Surface Electromyography To Evaluate And Monitor Back Pain | Jul 15, 2024 | Jul 20, 2025 | A noninvasive procedure that records the summation of muscle electrical activity, paraspinal surface... | View |
| 02.001.016 | Terapia con potenciacion con insulina | Dec 31, 1969 | NA | Na... | View |
| 02.001.017 | Laser Treatment Of Active Acne | Mar 23, 2020 | Policy Archived | Acne is a condition of the pilosebaceous follicular glands that affects mainly adolescents and young adults... | View |
| 02.001.018 | Electrostimulation And Electromagnetic Therapy For Treating Wounds | Feb 05, 2024 | Feb 20, 2025 | Electrostimulation (electrical stimulation) refers to the application of electrical current through... | View |
| 02.001.019 | Estimulación sensorial en pacientes comatosos | Dec 31, 1969 | NA | Na... | View |
| 02.001.020 | Endovascular Procedures For Intracranial Arterial Disease (Atherosclerosis And Aneurysms) | May 13, 2024 | May 20, 2025 | Intracranial arterial disease includes thromboembolic events, vascular stenoses, and aneurysms. endovascular... | View |
