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
10.001.005 Cirugía intentada Aug 2017 ... View
10.001.006 Procedimientos independientes Aug 2017 ... View
10.001.007 Códigos U May 2015 ... View
10.001.008 Procedimiento con informe (by report) May 2016 ... View
10.001.009 Procedimientos con asteriscos en la tarifa Aug 2017 ... View
10.001.010 Ambulancias y servicios de transportación médica May 2016 ... View
10.001.013 Clinical Trials Nov 2018 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 Sep 2025 Telemedicine is the remote exchange of medical information through secure electronic communication to support... View
10.001.026 Glucometers And Supplies Nov 2018 A blood glucose monitor (glucometer) is a portable, battery-operated device used to determine the blood... View
10.002.001 Chiropractic Services Sep 2024 The primary mode of chiropractic treatment is manual or instrument-assisted manipulation or adjustment.... View
10.002.002 Servicios de Sicólogos Clínicos Jul 2025 A clinical psychologist refers to a person or health professional who holds a master's or doctoral... View
10.002.003 Servicios de Optometría Aug 2017 ... View
10.002.006 Osteopathy Doctors’ Services Jul 2022 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 2024 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 2016 ... View
10.002.010 Acupuncture Apr 2022 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 2024 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 2023 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 2016 ... View
11.001.005 In Vitro Chemoresistance And Chemosensitivity Assays Jul 2025 In vitro chemoresistance and chemosensitivity assays have been developed to provide information about the... View