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 |
|---|---|---|---|---|
| 07.001.043 | Autografts And Allografts In The Treatment Of Focal Articular Cartilage Lesions | May 2026 | Osteochondral grafts are used to repair full-thickness chondral defects involving a joint. in the case of... | View |
| 07.001.044 | Implantable Bone-Conduction And Bone-Anchored Hearing Aids | Mar 2025 | Sensorineural, conductive, and mixed hearing loss may be treated with various devices, including conventional... | View |
| 07.001.045 | Surgical Ventricular Restoration | Mar 2026 | Surgical ventricular restoration is designed to restore or remodel the left ventricle to its normal,... | View |
| 07.001.048 | Intraoperative Neurophysiologic Monitoring | May 2026 | Intraoperative neurophysiologic monitoring describes a variety of procedures used to monitor the integrity of... | View |
| 07.001.051 | Balloon Ostial Dilation For Treatment Of Chronic Rhinosinusitis | Mar 2026 | Balloon ostial dilation (bod, also known as balloon sinuplasty) is proposed as an alternative to functional... | View |
| 07.001.053 | Auditory Brainstem Implant | Mar 2026 | An auditory brainstem implant (abi) is designed to restore some hearing in people with neurofibromatosis type... | View |
| 07.001.054 | Periureteral Bulking Agents As A Treatment Of Vesicoureteral Reflux | Sep 2026 | Most commonly seen in children, vesicoureteral reflux (vur) is the retrograde flow of urine from the bladder... | View |
| 07.001.058 | Artificial Intervertebral Disc: Cervical Spine | May 2026 | Several prosthetic devices are currently available for cervical disc arthroplasty. cervical disc arthroplasty... | View |
| 07.001.065 | Artificial Intervertebral Disc: Lumbar Spine | Mar 2026 | Total disc replacement, using an artificial intervertebral disc designed for the lumbar spine, is proposed as... | View |
| 07.001.072 | Axial Lumbosacral Interbody Fusion | May 2026 | Axial lumbosacral interbody fusion (also called presacral, transsacral, or paracoccygeal interbody fusion) is... | View |
| 07.001.073 | Interspinous And Interlaminar Stabilization/Distraction Devices (Spacers) | May 2026 | Interspinous and interlaminar implants (spacers) stabilize or distract the adjacent lamina and/or spinous... | View |
| 07.001.079 | Occipital Nerve Stimulation | May 2026 | Occipital nerve stimulation delivers a small electrical charge to the occipital nerve intended to prevent... | View |
| 07.001.080 | Surgical Treatment Of Femoroacetabular Impingement | May 2026 | Femoroacetabular impingement results from localized compression within the joint as a result of an anatomic... | View |
| 07.001.081 | Laser Treatment Of Wine Stains | Mar 2026 | Destruction of cutaneous vascular proliferative lesions (cvpls) involves the use of laser or other... | View |
| 07.001.082 | Bronchial Valves | Jul 2026 | Bronchial valves are synthetic devices deployed with bronchoscopy into ventilatory airways of the lung to... | View |
| 07.001.086 | Image-Guided Minimally Invasive Decompression For Spinal Stenosis | May 2026 | Image-guided minimally invasive decompression describes a percutaneous procedure for decompression of the... | View |
| 07.001.088 | Lung Volume Reduction Surgery For Severe Emphysema | Jul 2026 | Description – intro lung volume reduction surgery (lvrs) is proposed as a treatment option for patients... | View |
| 07.001.091 | Electrical Stimulation Of The Spine As An Adjunct To Spinal Fusion Procedures | May 2026 | Both invasive and noninvasive electrical bone growth stimulators have been investigated as an adjunct to... | View |
| 07.001.092 | Interspinous Fixation (Fusion) Devices | May 2026 | Interspinous fixation (fusion) devices are being developed to aid in the stabilization of the spine. they are... | View |
| 07.001.098 | Debridment | Jun 2026 | A wound is a disruption of the normal structure and function of the skin and skin architecture. an acute... | View |