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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 |
|---|---|---|---|---|---|
| 07.001.052 | Percutaneous and Subcutaneous Tibial Nerve Stimulation | Sep 12, 2023 | Sep 20, 2024 | Percutaneous tibial nerve stimulation for an initial 12-week course is considered medically necessary for... | Ver |
| 07.001.053 | Auditory Brainstem Implant | Mar 07, 2024 | Mar 20, 2025 | Unilateral use of an auditory brainstem implant (using surface electrodes on the cochlear nuclei) may be... | Ver |
| 07.001.054 | Periureteral Bulking Agents as a Treatment of Vesicoureteral Reflux | Sep 05, 2023 | Sep 20, 2024 | Periureteral bulking agents may be considered medically necessary as a treatment of vesicoureteral reflux... | Ver |
| 07.001.055 | Thermal Capsulorrhaphy as a Treatment of Joint Instability | Apr 29, 2019 | Policy Archived | Thermal capsulorrhaphy is considered not medically necessary as a treatment of joint instability, including,... | Ver |
| 07.001.056 | Transmyocardial Revascularization | Mar 18, 2024 | Mar 20, 2025 | Transmyocardial laser revascularization may be considered medically necessary for individuals with class iii... | Ver |
| 07.001.058 | Artificial Intervertebral Disc: Cervical Spine | May 17, 2024 | May 20, 2025 | Cervical disc arthroplasty may be considered medically necessary when all of the following criteria are... | Ver |
| 07.001.060 | Radiofrequency Ablation of Primary or Metastatic Liver Tumors | Aug 10, 2023 | Aug 20, 2024 | Radiofrequency ablation of primary, inoperable (eg, due to location of lesion[s] and/or comorbid conditions),... | Ver |
| 07.001.061 | Wireless Pressure Sensors in Endovascular Aneurysm Repair | May 08, 2019 | Policy Archived | Use of wireless pressure sensors is considered investigational for the management (intraoperative and/or... | Ver |
| 07.001.064 | Transanal Endoscopic Microsurgery | Dec 04, 2023 | Dec 20, 2024 | Transanal endoscopic microsurgery may be considered medically necessary for treatment of rectal adenomas,... | Ver |
| 07.001.065 | Artificial Intervertebral Disc: Lumbar Spine | May 20, 2024 | May 20, 2025 | Artificial intervertebral discs of the lumbar spine are considered investigational.... | Ver |
| 07.001.066 | Risk-Reducing Mastectomy | Aug 08, 2023 | Aug 20, 2024 | Risk-reducing mastectomy may be considered medically necessary in patients at high risk of breast cancer.... | Ver |
| 07.001.067 | Nerve Graft With Radical Prostatectomy | May 16, 2024 | May 20, 2025 | Unilateral or bilateral nerve graft is considered investigational in patients who have had resection of one... | Ver |
| 07.001.069 | Isolated Limb Perfusion/Infision for Malignant Melanoma | Apr 15, 2019 | Policy Archived | Isolated limb perfusion (ilp) when used as a therapeutic treatment of local recurrence of nonresectable... | Ver |
| 07.001.070 | TONSILECTOMIA ASISTIDA POR LASER | May 16, 2016 | Policy Archived | Tonsilectomia asistida por láser realizada en una o más sesiones no procede para pago. tonsilectomia... | Ver |
| 07.001.071 | Radiofrequency Ablation of Miscellaneous Solid Tumors Excluding Liver Tumors | Oct 10, 2023 | Oct 20, 2024 | Osteolytic bone metastases radiofrequency ablation may be considered medically necessary to palliate pain... | Ver |
| 07.001.072 | Axial Lumbosacral Interbody Fusion | May 16, 2024 | May 20, 2025 | Axial lumbosacral interbody fusion is considered... | Ver |
| 07.001.073 | Interspinous and Interlaminar Stabilization/Distraction Devices (Spacers) | May 12, 2024 | May 20, 2025 | Interspinous or interlaminar distraction devices as a stand-alone procedure are considered investigational as... | Ver |
| 07.001.074 | Facet Joint Denervation | Dec 05, 2023 | Dec 20, 2024 | Nonpulsed radiofrequency denervation of cervical facet joints (c3-4 and below) and lumbar facet joints is... | Ver |
| 07.001.075 | Extracranial Carotid Artery Stenting | Jun 07, 2024 | Jun 20, 2025 | Carotid angioplasty with associated stenting and embolic protection may be considered medically necessary in... | Ver |
| 07.001.076 | Saturation Biopsy for Diagnosis, Staging, and Management of Prostate Cancer | Aug 10, 2023 | Aug 20, 2024 | Saturation biopsy is considered investigational in the diagnosis, staging, and management of prostate... | Ver |
