This functionality is implemented using Javascript. It cannot work without it, etc...

We are loading the information...

Skip to main content

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
02.001.021 Inyecciones intratimpánicas en el tratamiento de la enfermedad de Meniere o perd Jul 01, 2024 Retired Policy Definition meniere's disease, also known as endolymphatic hydrops, is a middle ear disorder of unknown... View
02.001.022 Quantitative Sensory Testing Jul 15, 2024 Jul 20, 2025 Quantitative sensory testing (qst) systems are used for the noninvasive assessment and quantification of... View
02.001.024 Onda de choque extracorporea en el tratamiento de la enfermedad de peyronie Dec 31, 1969 NA Na... View
02.001.025 High Intensity Laser Therapy Nov 09, 2022 Policy Archived Conventional laser therapy has been used in europe for more than 25 years. up to this moment, this therapy... View
02.001.026 Electromyography And Nerve Conduction Studies Sep 09, 2024 Jul 20, 2025 Electromyography (emg) and nerve conduction studies (ncs), also collectively known as an electrodiagnostic... View
02.001.027 Percutaneous Treatment Of Fracture Non-Unions Or Bone Defects With Autologous Bone Marrow With Demineralized Bone Matrix (Dbm) Apr 02, 2019 Policy Archived The standard treatment of problem fractures or osseous defects has been an autologous cancellous bone graft... View
02.001.028 Psoralens con luz ultravioleta A (PUVA) Dec 31, 1969 NA Na... View
02.001.029 MIRINGOTOMÍA Y TIMPANOSTOMÍA ASISTIDAS CON LASER Dec 31, 1969 NA Na... View
02.001.030 Actigraphy Aug 06, 2024 Jul 20, 2025 Actigraphy refers to the assessment of body movement activity patterns using devices, typically placed on the... View
02.001.031 Biofeedback As A Treatment Of Chronic Pain Dec 09, 2024 Dec 20, 2025 Biofeedback is a technique intended to teach patients self-regulation of certain physiologic processes not... View
02.001.032 Dynamic Posturography Mar 14, 2024 Mar 20, 2025 Dynamic posturography tests a patient’s balance control in situations intended to isolate factors that... View
02.001.033 Transcranial Magnetic Stimulation As A Treatment Of Depression And Other Psychiatric/Neurologic Disorders Nov 19, 2024 Nov 20, 2025 Transcranial magnetic stimulation (tms) is a noninvasive method of delivering electrical stimulation to the... View
02.001.034 Endoscopic Radiofrequency Ablation Or Cryoablation For Barrett Esophagus Dec 02, 2024 Dec 20, 2025 In barrett esophagus (be), the normal squamous epithelium is replaced by specialized columnar-type... View
02.001.036 Rinomanometria y Rinometria Acustica / Optica Dec 31, 1969 NA Na... View
02.001.037 Sublingual Immunotherapy As A Technique Of Allergen-Specific Therapy Nov 06, 2024 Nov 20, 2025 Sublingual immunotherapy (slit) is a potential alternative to subcutaneous immunotherapy (scit) for providing... View
02.001.038 Evaluación cardiovascular por tabla de oscilación (Tilt Table) Dec 31, 1969 NA Na... View
02.001.039 Análisis de la marcha (Gait Anlysis) Dec 31, 1969 NA Na... View
02.001.041 Biofeedback For Miscellaneous Indications Dec 20, 2024 Dec 20, 2025 Biofeedback is a technique intended to teach patients self-regulation of certain physiologic processes that... View
02.001.042 Home Oxygen Therapy Aug 22, 2023 Policy Archived Home oxygen therapy is used to treat and prevent symptoms and manifestations of hypoxemia. home oxygen... View
02.001.043 Interventions For Progressive Scoliosis May 13, 2024 May 20, 2025 Of safety and probable benefit (sspb): the tether vertebral body tethering system. 2019;... View

Want to be up to date on topics like health, trending news, useful tips, lifestyles and more?

Subscribe to our blog and don't miss out on anything!

Subscribe to the blog

We want to personalize the content according to your preferences

Please select one or more categories to continue

Thanks for subscribing!

You will receive information of interest in your email.

787-277-6653 787-474-6326