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
08.003.013 Functional Neuromuscular Electrical Stimulation Apr 2026 Functional electrical stimulation (fes) involves the use of an orthotic device or exercise equipment with... View
09.003.004 Intraocular Radiotherapy For Age-Related Macular Degeneration Apr 2026 Intraocular radiation, including brachytherapy, proton beam therapy, and stereotactic radiotherapy, are being... View
09.003.005 Intravitreal And Punctum Corticosteroid Implants May 2026 An intravitreal implant is a drug delivery system, injected or surgically implanted in the vitreous of the... View
09.003.009 Eyelid Thermal Pulsation For The Treatment Of Dry Eye Syndrome Apr 2026 Thermal pulsation is a treatment option for meibomian gland dysfunction. meibomian gland dysfunction is... View
09.003.011 Keratoprosthesis Apr 2026 A keratoprosthesis, consisting of a central optic held in a cylindrical frame, is an artificial cornea... View
09.003.014 Corneal Collagen Cross-Linking Mar 2026 Corneal collagen cross-linking is a photochemical procedure approved by the u.s. food and drug administration... View
09.003.026 Viscocanalostomy And Canaloplasty Apr 2026 Glaucoma surgery is intended to reduce intraocular pressure when the target intraocular pressure cannot be... View
09.003.031 Ophthalmologic Techniques That Evaluate The Posterior Segment For Glaucoma Apr 2026 Several techniques have been developed to measure the thickness of the optic nerve and retinal nerve fiber... View
09.003.033 Sensorimotor Examination Mar 2026 Sensorimotor examination is used to evaluate ocular motility, binocular vision, and alignment abnormalities,... View
10.002.001 Chiropractic Services Jun 2026 The primary mode of chiropractic treatment is manual or instrument-assisted manipulation or adjustment.... View
10.002.006 Osteopathy Doctors’ Services Jun 2026 The osteopath is a health professional whose studies are equivalent to a doctorate. his training emphasizes... View
11.001.007 Identification Of Microorganisms Using Nucleic Acid Probes Sep 2026 Nucleic acid probes are available for the identification of a wide variety of microorganisms. nucleic acid... View
11.001.012 Jak2 And Mpl, Testing For Myeloproliferative Neoplasms Sep 2026 Somatic (acquired) genetic variants in jak2, mpl, and calr genes have been implicated as the underlying... View
11.001.046 Maternal Serum Biomarkers for Prediction of Adverse Obstetric Outcomes Mar 2026 Improved accuracy of the identification of pregnant people at risk of preeclampsia and spontaneous preterm... View
11.001.047 Multicancer Early Detection Testing Jul 2026 Many cancers appear to have a better prognosis if diagnosed early in their natural history. this has led to... View
11.003.002 Genetic Testing For Predisposition To Inherited Hypertrophic Cardiomyopathy Apr 2026 Familial hypertrophic cardiomyopathy is an inherited condition caused by a disease associated variant in 1 or... View
11.003.006 Pruebas Genéticas para el Tratamiento Helico Bacter Pylori May 2026 Helicobacter pylori is a bacterium associated with a number of gastrointestinal problems, such as peptic... View
11.003.008 Cytochrome P450 Genotype-Guided Treatment Strategy Jul 2026 The cytochrome p450 (cyp450) family is involved in the metabolism of many currently administered drugs, and... View
11.003.012 Genetic Testing For Inherited Thrombophilia May 2026 Inherited thrombophilias are a group of disorders that predispose individuals to thrombosis. genetic testing... View
11.003.014 Noninvasive Fetal Rhd Genotyping Using Cell-Free Fetal Dna Sep 2026 Rhesus d (rhd)-negative women who are exposed to rhd-positive red blood cells can develop anti-rhd... View