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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 |
|---|---|---|---|---|---|
| 02.005.004 | Oximetría continua | May 10, 2016 | Policy Archived | ... | View |
| 02.005.005 | Terapia con inhibidores de Alfa 1 Proteinasa | May 10, 2016 | Policy Archived | ... | View |
| 02.005.006 | Diagnosis of Obstructive Sleep Apnea Syndrome | Jul 02, 2024 | Jul 20, 2025 | Obstructive sleep apnea (osa) syndrome is characterized by repetitive episodes of upper airway obstruction... | View |
| 02.005.007 | Espirometría Casera | Aug 22, 2017 | Policy Archived | ... | View |
| 02.005.008 | Síndrome de Obstrucción en el Conducto Aéreo Superior | Nov 16, 2017 | Policy Archived | ... | View |
| 02.005.009 | Non-Invasive Positive Airway Pressure for Chronic Obstructive Pulmonary Disease | Apr 15, 2024 | Oct 20, 2024 | Respiratory failure is characterized by low arterial blood oxygen (hypoxemia, pao2) and/or high arterial... | View |
| 02.005.010 | Medical Management of Obstructive Sleep Apnea Syndrome | Jul 18, 2024 | Jul 20, 2025 | Obstructive sleep apnea (osa) syndrome is characterized by repetitive episodes of upper airway obstruction... | View |
| 02.007.001 | ESTIMULACION REPETITIVA DEL NERVIO (RNS) | Jun 22, 2023 | Policy Archived | Repetitive nerve stimulation (rns) and single-fiber electromyography (sfemg) are important confirmatory tests... | View |
| 02.007.003 | ELECTROENCEFALOGRAFIA CON EKG | May 10, 2016 | Policy Archived | ... | View |
| 02.007.004 | Somatosensory Evoked Potential Studies Visual/Auditory | Nov 10, 2021 | Policy Archived | Evoked potentials are somatosensory stimuli, visual and/or auditory. the same, when applied activate... | View |
| 02.007.006 | Topografía cerebral (“Topographic Brain Mapping”) | Nov 16, 2017 | Policy Archived | ... | View |
| 02.007.007 | Electroencefalografía digital | Jun 23, 2023 | Policy Archived | It is the technological method of acquiring and recording the electroencephalogram without the use of paper.... | View |
| 02.007.008 | Electroencephalograms (Eeg) | Jul 11, 2023 | Policy Archived | An electroencephalogram (eeg) is a recording of electrical current potentials spontaneously from nerve cells... | View |
| 02.007.009 | Autonomic Nervous System Testing | Jul 18, 2024 | Jul 20, 2025 | The autonomic nervous system (ans) controls physiologic processes that are not under conscious control.... | View |
| 02.007.011 | Neuropsychological Test | Nov 26, 2024 | Policy Archived | Neuropsychology is defined as the study (knowledge, evaluation and modification) of the brain-behavior... | View |
| 02.007.012 | Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions | Jul 16, 2024 | Jul 20, 2025 | Peripheral nerve stimulation (pns) is a percutaneous system consisting of leads, electrodes, and a pulse... | View |
| 02.009.002 | Cuidado crítico pediátrico | May 10, 2016 | Policy Archived | ... | View |
| 02.009.003 | Cernimiento auditivo neonatal | Jun 23, 2023 | Policy Archived | The diagnosis of congenital hearing loss was previously made at an average age of 13 months for infants with... | View |
| 02.009.004 | PRUEBAS DE FUNCIÓN PULMONAR EN INFANTES | May 10, 2016 | Policy Archived | ... | View |
| 03.001.001 | Psycotheraphy | Nov 11, 2020 | Policy Archived | The description of codes 90785-90840 contemplates the treatment of a mental condition or behavioral... | View |
