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 |
|---|---|---|---|---|---|
| 05.001.040 | Repository Corticotropin Injection | Nov 15, 2023 | Nov 20, 2024 | Repository corticotropin injection may be considered medically necessary for the treatment of infantile... | Ver |
| 05.001.041 | Injectable Clostridial Collagenase for Fibroproliferative Disorders | Apr 17, 2024 | Apr 20, 2025 | Injectable clostridial collagenase for the treatment of dupuytren's contracture in adults with a palpable... | Ver |
| 05.001.042 | Esketamine Nasal Spray for Treatment-Resistant Depression | Nov 15, 2023 | Nov 20, 2024 | Treatment-resistant depression esketamine nasal spray may be considered medically necessary if all of... | Ver |
| 05.001.043 | Hematopoietic Colony-Stimulating Factors (CSFs) | Apr 12, 2024 | Oct 20, 2024 | Trple s considers short-acting granulocyte colony stimulating factors (g-csfs), medically necessary for... | Ver |
| 05.001.044 | Polivy® (polatuzumab vedotin-piiq) | Oct 26, 2023 | Oct 20, 2024 | Polatuzumab vedotin-piiq (polivy) is considered medically necessary for the treatment of adult patients with... | Ver |
| 05.001.045 | Lumasiran for Primary Hyperoxaluria Type 1 | Aug 08, 2023 | Aug 20, 2024 | Initial treatment lumasiran may be considered medically necessary if all of the following conditions are... | Ver |
| 05.001.046 | Monoclonal Antibodies for Treatment of Alzheimer Disease | Nov 15, 2023 | Nov 20, 2024 | The use of aducanumab and lecanemab is considered investigational for all indications including treatment... | Ver |
| 05.001.047 | Fibrin Sealant | Oct 26, 2023 | Oct 20, 2024 | The use of fibrin sealants is considered medically necessary in situations where usual and standard... | Ver |
| 05.001.048 | Biological Treatments for Refractory Myasthenia Gravis | Jan 08, 2024 | Jan 20, 2025 | Eculizumab and ravulizumab-cwvz - initial treatment eculizumab and ravulizumab-cwvz may be... | Ver |
| 05.001.049 | Givosiran for Acute Hepatic Porphyria | Aug 16, 2023 | Aug 20, 2024 | Initial treatment givosiran may be considered medically necessary if all of the following conditions are... | Ver |
| 05.001.050 | Omidubicel as Adjunct Treatment for Hematologic Malignancies | Sep 08, 2023 | Sep 20, 2024 | Omidubicel the product label of omidubicel recommends that patients be treated under the supervision of a... | Ver |
| 05.002.001 | Chimeric Antigen Receptor Therapy for Multiple Myeloma | Apr 19, 2024 | Apr 20, 2025 | Idecabtagene vicleucel and ciltacabtagene autoleucel may be considered medically necessary for individuals... | Ver |
| 05.003.001 | Gene Therapies for Thalassemia | Apr 17, 2024 | Apr 20, 2025 | Betibeglogene autotemcel and exagamglogene autotemcel are considered medically necessary for individuals with... | Ver |
| 05.003.002 | Gene Therapies for Sickle Cell Disease | Apr 18, 2024 | Apr 20, 2025 | Exagamglogene autotemcel and lovotibeglogene autotemcel exagamglogene autotemcel and lovotibeglogene... | Ver |
| 06.001.001 | DOPPLER TRANSCRANEAL | Jun 23, 2017 | Policy Archived | El doppler transcraneal se considera para pago en: monitoreo del vasoespasmo en pacientes con hemorragia... | Ver |
| 06.001.002 | IMAGEN POR RESONCIA MAGNÉTICA | May 10, 2016 | Policy Archived | La resonancia magnética requiere preautorización para evaluar la necesidad médica del servicio en las... | Ver |
| 06.001.003 | BIOPSIA DE MAMA DIRIGIDA POR MRI | May 10, 2016 | Policy Archived | La biopsia de mama asistida por vacío y guiada con mri se considera para pago bajo las siguientes... | Ver |
| 06.001.004 | Magnetic Resonance Angiography (MRA) of the Chest (excluding the heart) | Jul 11, 2023 | Policy Archived | Mra of the chest may be considered medically necessary in patients with the following indications in whom... | Ver |
| 06.001.005 | Bone Mineral Density Studies | Oct 02, 2023 | Oct 20, 2024 | Initial or repeat bone mineral density (bmd) measurement is not indicated unless the results will influence... | Ver |
| 06.001.006 | Screening and Diagnostic Mammography | Sep 07, 2023 | Policy Archived | Screening mammogram a screening mammography is a radiologic procedure furnished to a woman without signs... | Ver |
