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Políticas Médicas
Las políticas médicas son documentos que definen el reconocimiento de cubierta para tecnologías, procedimientos y tratamientos. Las declaraciones de necesidad médica en las políticas, sobre si una tecnología, procedimiento, tratamiento, suplido, equipo, medicamento u otro servicio mejora el resultado en la salud de la población para la cual dicha tecnología o tratamiento fue diseñado se basan en evidencia científica, estudios clínicos y opiniones profesionales de nuestros proveedores y de las organizaciones médicas reconocidas.
Cada documento desplegado en este sitio Web se provee con propósitos informativos solamente y no es una autorización, explicación de beneficios o un contrato. El recibir beneficios está sujeto a la satisfacción de todos los términos y condiciones de la cubierta. La tecnología médica cambia constantemente y nos reservamos el derecho de revisar y actualizar nuestras políticas periódicamente.
| ID | Título | Última Revisión | Siguiente Revisión | Descripción | Acceso |
|---|---|---|---|---|---|
| 01.001.020 | Transcutaneous Electrical Nerve Stimulation | Feb 28, 2024 | Jan 20, 2025 | A trial of transcutaneous electrical nerve stimulation (tens) of at least 30 days may be... | Ver |
| 01.001.027 | Interferential Current Stimulation | Jul 15, 2024 | Jul 20, 2025 | Interferential current stimulation is... | Ver |
| 02.001.015 | Paraspinal Surface Electromyography to Evaluate and Monitor Back Pain | Jul 15, 2024 | Jul 20, 2025 | Paraspinal surface electromyography is considered investigational as a technique to diagnose or monitor back... | Ver |
| 02.001.020 | Endovascular Procedures for Intracranial Arterial Disease (Atherosclerosis and Aneurysms) | May 13, 2024 | May 20, 2025 | Intracranial stent placement may be considered medically necessary as part of the endovascular treatment of... | Ver |
| 02.001.026 | Electromyography and Nerve Conduction Studies | Jul 15, 2024 | Jul 20, 2025 | The following list gives specific diagnoses, according to categories of testing listed in the policy... | Ver |
| 02.001.031 | Biofeedback as a Treatment of Chronic Pain | Dec 11, 2023 | Dec 20, 2024 | Biofeedback as a treatment of chronic pain, including but not limited to low back pain,... | Ver |
| 02.001.077 | Epidural Steroid Injections for Neck or Back Pain | Dec 20, 2023 | Dec 20, 2024 | The diagnosis of lumbar radiculopathy is typically made by a combination of suggestive signs and symptoms in... | Ver |
| 02.002.018 | Progenitor Cell Therapy for the Treatment of Damaged Myocardium due to Ischemia | Jun 18, 2024 | Jun 20, 2025 | Progenitor cell therapy, including but not limited to skeletal myoblasts or hematopoietic cells, is... | Ver |
| 02.007.004 | Somatosensory evoked potential studies visual/auditory | Nov 10, 2021 | Policy Archived | Triple-s will consider for payment studies of evoked potentials when they are performed with the purpose of:... | Ver |
| 05.001.004 | Botulinum Toxin | Mar 12, 2024 | Nov 20, 2024 | The use of botulinum toxin may be considered medically necessary for the following:... | Ver |
| 05.001.015 | Advanced Therapies for Pharmacologic Treatment of Pulmonary Hypertension | Dec 20, 2023 | Dec 20, 2024 | Pulmonary arterial hypertension (pah) combination therapy for the treatment of pah (world health... | Ver |
| 06.001.039 | Dynamic Spinal Visualization and Vertebral Motion Analysis | Oct 05, 2023 | Oct 20, 2024 | The use of dynamic spinal visualization is considered investigational. vertebral motion analysis is... | Ver |
| 06.001.045 | Positional Magnetic Resonance Imaging | Dec 14, 2023 | Policy Archived | Positional (nonrecumbent) magnetic resonance imaging is considered investigational, including its use in the... | Ver |
| 06.001.050 | Duplex Sanning | Nov 14, 2019 | Policy Archived | The duplex scanning in the evaluation of the arterial / venous flow of abdominal, pelvic organs and of the... | Ver |
| 06.001.061 | Diagnosis and Treatment of Sacroiliac Joint Pain | Dec 04, 2023 | Dec 20, 2024 | Arthrography of the sacroiliac joint (sij) is considered investigational. injection of anesthetic for... | Ver |
| 07.001.009 | Computer-Assisted Navigation for Orthopedic Procedures | May 17, 2024 | May 20, 2025 | Computer-assisted surgical navigation for orthopedic procedures is considered... | Ver |
| 07.001.014 | Reduction Mammaplasty for Breast-Related Symptoms | Mar 14, 2024 | Mar 20, 2025 | Reduction mammaplasty may be considered medically necessary for the treatment of macromastia when... | Ver |
| 07.001.029 | Spinal Cord and Dorsal Root Ganglion Stimulation | May 17, 2024 | May 20, 2025 | Spinal cord stimulation with standard or high-frequency stimulation may be considered medically... | Ver |
| 07.001.037 | Bone Morphogenetic Protein | May 12, 2024 | May 20, 2025 | Use of recombinant human bone morphogenetic protein-2 (infuse™) may be considered medically necessary in... | Ver |
| 07.001.048 | Intraoperative Neurophysiologic Monitoring | May 06, 2024 | May 20, 2025 | Intraoperative neurophysiologic monitoring, which includes somatosensory-evoked potentials, motor-evoked... | Ver |
