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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 |
|---|---|---|---|---|---|
| 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 |
| 07.001.030 | Vagus Nerve Stimulation | Mar 15, 2024 | Mar 20, 2025 | Vagus nerve stimulation may be considered medically necessary as a treatment of medically refractory... | Ver |
| 07.001.031 | Deep Brain Stimulation | May 12, 2024 | May 20, 2025 | Unilateral deep brain stimulation of the thalamus may be considered medically necessary in individuals with... | Ver |
| 07.001.032 | Phototherapeutic Keratectomy | Jun 23, 2023 | Policy Archived | Phototherapeutic keratectomy is considered for payment when used as an alternative to lamellar keratoplasty... | Ver |
| 07.001.033 | OTOPLASTY | Nov 09, 2022 | Policy Archived | Reconstructive surgery of the ear is considered for payment if it meets the following criteria: • when... | Ver |
| 07.001.034 | Extracorporeal Shock Wave Lithotripsy (ESWL) | Jun 26, 2023 | Policy Archived | Extracorporeal shock wave lithotripsy (eswl) is considered for payment at the treatment of kidney stones.... | 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 |
| 07.001.038 | Automated Percutaneous and Percutaneous Endoscopic Discectomy | Jul 12, 2022 | Jul 12, 2023 | Automated percutaneous discectomy is considered investigational as a technique of intervertebral disc... | Ver |
| 07.001.039 | Meniscal Allografts and Other Meniscal Implants | May 06, 2024 | May 20, 2025 | Meniscal allograft transplantation may be considered medically necessary in patients who have had a prior... | Ver |
| 07.001.040 | Post-Surgery Reconstructive Surgery Bariatric | Jun 23, 2023 | Policy Archived | Reconstructive procedures on the breasts, abdomen, back and lower back when you meet the following criteria... | Ver |
| 07.001.041 | Cochlear Implant | Mar 06, 2024 | Mar 20, 2025 | Bilateral or unilateral cochlear implantation of a u.s. food and drug administration (fda)-approved cochlear... | Ver |
| 07.001.042 | Percutaneous Intradiscal Electrothermal Annuloplasty, Radiofrequency Annuloplasty, Biacuplasty and Intraosseous Basivertebral Nerve Ablation | May 06, 2024 | May 20, 2025 | Percutaneous annuloplasty (eg, intradiscal electrothermal annuloplasty, intradiscal radiofrequency... | Ver |
| 07.001.043 | Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions | May 20, 2024 | May 20, 2025 | Fresh osteochondral allografting may be considered medically necessary as a technique to repair:... | Ver |
| 07.001.044 | Implantable Bone-Conduction and Bone-Anchored Hearing Aids | Mar 18, 2024 | Mar 20, 2025 | Unilateral or bilateral fully or partially implantable bone-conduction (bone-anchored) hearing aid(s) may be... | Ver |
| 07.001.045 | Surgical Ventricular Restoration | Mar 06, 2024 | Mar 20, 2024 | Surgical ventricular restoration is considered investigational for the treatment of ischemic dilated... | Ver |
| 07.001.047 | CIRUGIA ROBOTICA (Prostatectomía Radical Laparoscópica) | May 10, 2016 | Policy Archived | La prostatectomía radical por laparoscopía asistida por robot se considera para... | Ver |
| 07.001.048 | Intraoperative Neurophysiologic Monitoring | May 06, 2024 | May 20, 2025 | Intraoperative neurophysiologic monitoring, which includes somatosensory-evoked potentials, motor-evoked... | Ver |
| 07.001.049 | Percutaneous Nephrostolithotomy and Lithetripsy for Kidney Stones | Sep 05, 2019 | Policy Archived | Percutaneous nephrostolithotomy and lithotripsy are considered medically necessary for treating upper urinary... | Ver |
| 07.001.050 | Implantable Cardioverter Defibrillators | Jun 12, 2024 | Jun 20, 2025 | Transvenous implantable cardioverter defibrillator adults the use of the automatic implantable... | Ver |
| 07.001.051 | Balloon Ostial Dilation for Treatment of Chronic and Recurrent Acute Rhinosinusitis | Mar 07, 2024 | Mar 20, 2025 | Use of a catheter-based inflatable device (balloon ostial dilation) for the treatment of chronic... | Ver |
