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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 |
|---|---|---|---|---|---|
| 02.007.012 | Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions | Jul 16, 2024 | Jul 20, 2025 | Peripheral nerve stimulation as a treatment for chronic pain is considered... | Ver |
| 02.009.002 | CUIDADO CRITICO PEDIATRICO | May 10, 2016 | Policy Archived | Los servicios de cuidado pediátrico crítico se proveen (pero no están limitados) a pacientes con fallo en... | Ver |
| 02.009.003 | Neonatal Auditory Screening | Jun 23, 2023 | Policy Archived | The neonatal hearing screening program establishes performing hearing screening tests on all infants before... | Ver |
| 02.009.004 | PRUEBAS DE FUNCIÓN PULMOR EN INFANTES | May 10, 2016 | Policy Archived | Las pruebas de función pulmonar en infantes y niños no se consideran para pago ya que su utilidad no ha... | Ver |
| 03.001.001 | Psycotheraphy | Nov 11, 2020 | Policy Archived | The patient receives medical evaluation and management services. these services involve a variety of unique,... | Ver |
| 03.001.002 | VISITA COLATERAL | May 10, 2016 | Policy Archived | Debe haber una nota separada en el expediente, donde se identifique la relación de la persona con el... | Ver |
| 03.001.003 | Opioid Antagonists Under Heavy Sedation or General Anesthesia as a Technique of Opioid Detoxification | Apr 02, 2019 | Policy Archived | Opioid antagonists under heavy sedation or anesthesia are considered investigational as a technique for... | Ver |
| 03.001.004 | TERAPIA ELECTROCONVULSIVA | May 10, 2016 | Policy Archived | La terapia electroconvulsiva se considera para pago como tratamiento para la depresión mayor, desórdenes... | Ver |
| 03.001.005 | AUTISM DISORDERS / PERVASIVE DEVELOPMENT DISORDERS | Nov 14, 2019 | Policy Archived | Triple - s will cover for payment the following services as medically necessary in the evaluation of a known... | Ver |
| 03.001.006 | PSYCHIATRY SERVICES | Nov 14, 2019 | Policy Archived | Psychiatric services are medically... | Ver |
| 03.001.007 | HOME PSYCHIATRIC SERVICES | Nov 14, 2019 | Policy Archived | Psychiatric services in the home will be covered for payment when they comply with what is expressed in the... | Ver |
| 03.001.008 | Quantitative Electroencephalography as a Diagnostic Aid for Attention-Deficit/Hyperactivity Disorder | Nov 07, 2023 | Nov 20, 2024 | Quantitative electroencephalographic-based assessment of the theta/beta ratio is considered investigational... | Ver |
| 03.001.009 | Digital Health Therapies for Substance Use Disorders | Aug 17, 2024 | Aug 20, 2024 | Digital health therapies for individuals with substance use disorders are... | Ver |
| 03.001.010 | Digital Health Technologies for Attention Deficit/Hyperactivity Disorder | Aug 14, 2023 | Aug 20, 2024 | The use of endeavorrx is considered investigational for all indications including... | Ver |
| 03.003.001 | Therapeutic Radiopharmaceuticals for Prostate Cancer | Sep 08, 2023 | Sep 20, 2024 | Therapeutic radiopharmaceuticals for prostate cancer using lutetium (lu) 177 vipivotide tetraxetan... | Ver |
| 04.001.001 | Antepartum Fetal Evaluation | Jun 16, 2022 | Policy Archived | Conditions for which antepartum evaluation is considered for payment: decrease in fetal movements... | Ver |
| 04.001.003 | Home Uterine Activity monitoring | May 08, 2019 | Policy Archived | Home uterine activity monitoring through a monitoring device and/or daily nursing contact is considered not... | Ver |
| 04.001.005 | Cervical Cerclage | Jun 12, 2020 | Policy Archived | Cervical cerclage is medically necessary for the treatment of an incompetent cervix, which is one that has... | Ver |
| 04.001.007 | Occlusion of Uterine Arteries Using Transcatheter Embolization | Sep 21, 2020 | Sep 21, 2021 | Transcatheter embolization of uterine arteries as a treatment of uterine fibroids or as a treatment of... | Ver |
| 04.001.009 | Laparoscopic and Percutaneous Techniques for the Myolysis of Uterine Fibroids | Mar 18, 2024 | Mar 20, 2025 | Laparoscopic or transcervical radiofrequency ablation (rfa) as a treatment of symptomatic uterine fibroids is... | Ver |
