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 |
|---|---|---|---|---|---|
| 10.002.009 | 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 | Jul 03, 2025 | 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 10, 2025 | Jul 20, 2026 | 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 | Nov 10, 2025 | Nov 20, 2026 | 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 19, 2026 | Jan 20, 2027 | 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 11, 2025 | Sep 20, 2026 | Somatic (acquired) genetic variants in jak2, mpl, and calr genes have been implicated as the underlying... | View |
| 11.001.013 | Urinary Biomarkers For Cancer Screening, Diagnosis, And Surveillance | Jan 19, 2026 | Jan 20, 2027 | 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 | Jul 03, 2025 | 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 | Jul 03, 2025 | 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 09, 2026 | Jan 20, 2027 | 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 |
