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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 |
|---|---|---|---|---|---|
| 11.001.013 | Urinary Biomarkers For Cancer Screening, Diagnosis, And Surveillance | Jan 21, 2025 | Jan 20, 2026 | The diagnosis of bladder cancer is generally made by cystoscopy and biopsy. bladder cancer has a very high... | View |
| 11.001.016 | Serum Biomarker Tests For Multiple Sclerosis | Jun 08, 2020 | Policy Archived | Serum antibodies to polysaccharide-containing molecules, called glycans, and other serum biomarkers are... | View |
| 11.001.017 | Pharmacogenetic Testing For Pain Management | Feb 20, 2025 | Feb 20, 2026 | While multiple pharmacologic therapies are available for the management of acute and chronic pain, there is a... | View |
| 11.001.018 | Diagnóstico serológico de la enfermedad celiaca | Sep 21, 2016 | Policy Archived | ... | View |
| 11.001.020 | Detection Of Circulating Tumor Cells In The Management Of Patients With Cancer | May 30, 2019 | Policy Archived | The prognosis of cancer patients is often determined by the occurrence of metastatic disease. studies have... | View |
| 11.001.021 | Measurement Of Long-Chain Omega-3 Fatty Acids In Red Blood Cell Membranes As A Cardiac Risk Factor | May 22, 2019 | Policy Archived | Epidemiologic studies have reported that subjects who eat a diet high in fish have a reduced risk of sudden... | View |
| 11.001.022 | Homocysteine Testing In The Screening, Diagnosis, And Management Of Cardiovascular Disease And Venous Thromboembolic Disease | Jan 08, 2025 | Jan 20, 2026 | Homocysteine is an amino acid that has been evaluated as a potential marker of cardiovascular disease (cvd)... | View |
| 11.001.023 | Procalcitonin As A Marker In The Systemic Inflammatory Response | Nov 10, 2021 | Policy Archived | Severe infection and sepsis are frequent causes of morbidity and mortality in intensive care units. infection... | View |
| 11.001.024 | Laboratory Testing For Hiv Tropism | Jan 19, 2021 | Policy Archived | Hiv tropism testing can determine the predominant coreceptor protein used by hiv to infect target cells.... | View |
| 11.001.026 | Genotipo y Fenotipo en HIV | May 16, 2016 | Policy Archived | ... | View |
| 11.001.027 | Immune Cell Function Assay | Jan 08, 2025 | Jan 20, 2026 | Careful monitoring of lifelong immunosuppression is required to ensure the long-term viability of solid organ... | View |
| 11.001.029 | Prueba fibronectina fetal | May 16, 2016 | Policy Archived | ... | View |
| 11.001.032 | Evaluation of Biomarkers for Alzheimer Disease | Dec 10, 2024 | Nov 20, 2025 | Biochemical changes associated with the pathophysiology of alzheimer disease (ad) are being evaluated to aid... | View |
| 11.001.033 | Bone Turnover Markers For The Diagnosis And Management Of Osteoporosis And Diseases Associated With High Bone Turnover | Feb 05, 2025 | Feb 20, 2026 | Bone turnover markers are biochemical markers of either bone formation or bone resorption. commercially... | View |
| 11.001.034 | Fecal Analysis In The Diagnosis Of Intestinal Dysbiosis | Jan 08, 2025 | Jan 20, 2026 | Intestinal dysbiosis may be defined as a state of disordered microbial ecology that is believed to cause... | View |
| 11.001.036 | Quantitative Assay For Measurement Of Her2 Total Protein Expression And Her2 | Jan 19, 2021 | Policy Archived | Novel assays that quantitatively measure total human epidermal growth factor receptor 2 (her2) protein... | View |
| 11.001.037 | Intracellular Micronutrient Analysis | Jan 08, 2025 | Jan 20, 2026 | Commercial laboratories offer panels of tests evaluating intracellular levels of micronutrients (essential... | View |
| 11.001.038 | Multitarget Polymerase Chain Traction Testing For Diagnosis Of Bacterial Vaginosis | Jan 15, 2025 | Policy Archived | Bacterial vaginosis (bv) is a common medical condition resulting from an imbalance in the normal vaginal... | View |
| 11.001.039 | Nutrient/Nutritional Panel Testing | Jan 15, 2025 | Jan 20, 2026 | Multimarker nutritional panel testing is proposed for patients with certain chronic conditions (eg, mood... | View |
| 11.001.040 | Testing Serum Vitamin D Levels | Jan 15, 2025 | Jan 20, 2026 | Vitamin d, also known as calciferol, is a fat-soluble vitamin that has a variety of physiologic effects, most... | View |
