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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 |
|---|---|---|---|---|---|
| 07.001.058 | 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 |
| 07.001.065 | Artificial Intervertebral Disc: Lumbar Spine | May 20, 2024 | May 20, 2025 | Artificial intervertebral discs of the lumbar spine are considered investigational.... | Ver |
| 07.001.072 | Axial Lumbosacral Interbody Fusion | May 16, 2024 | May 20, 2025 | Axial lumbosacral interbody fusion is considered... | 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 |
| 07.001.084 | FUSION VERTEBRAL LUMBAR MINIMAMENTE INVASIVA | Aug 22, 2017 | Policy Archived | Los siguientes procedimientos se reconocen para pago: fusión anterior: alif-abierto fusión posterior:... | Ver |
| 07.001.091 | Electrical Stimulation of the Spine as an Adjunct to Spinal Fusion Procedures | May 16, 2024 | May 20, 2025 | Either invasive or noninvasive methods of electrical bone growth stimulation may be considered medically... | Ver |
| 07.001.102 | Lumbar Spinal Fusion | Oct 18, 2023 | Oct 20, 2024 | Lumbar spinal fusion may be considered medically necessary for any one of the following conditions:... | Ver |
| 07.001.118 | Percutaneous Electrical Nerve Stimulation, Percutaneous Neuromodulation Therapy, and Restorative Neurostimulation Therapy | Jul 17, 2024 | Jul 20, 2025 | Percutaneous electrical neurostimulation is considered investigational. percutaneous neuromodulation... | Ver |
| 07.001.146 | Discectomy | Oct 26, 2023 | Oct 20, 2024 | Lumbar discectomy traditional approach (open) automated percutaneous discectomy automated endoscopic... | Ver |
| 07.001.158 | Three-Dimensional Printed Orthopedic Implants | Sep 09, 2020 | Policy Archived | Three-dimensional (3d) printed orthopedic implants that have a design that is approved or cleared by the food... | Ver |
| 07.001.162 | Allograft Injection for Degenerative Disc Disease | Jun 18, 2024 | Jun 20, 2025 | Injection of allograft into the intervertebral disc for the treatment of degenerative disc disease is... | Ver |
| 07.002.001 | Intravenous Sedation | Sep 11, 2019 | Policy Archived | Triple-s salud does not routinely recognize separate sedation payment for endoscopic procedures. these... | Ver |
| 07.002.002 | Monitored Anesthesia Care | Dec 04, 2023 | Dec 20, 2024 | The use of monitored anesthesia care may be considered medically necessary for gastrointestinal endoscopy,... | Ver |
| 08.001.002 | Physical Therapy Services | Mar 25, 2024 | Policy Archived | However, not all studies have found a benefit for mld over standard management for reducing limb volume... | Ver |
| 08.001.006 | Vertebral Axial Decompression | May 20, 2024 | May 20, 2025 | Vertebral axial decompression is considered... | Ver |
| 08.001.009 | Low-Level Laser Therapy | Jul 19, 2024 | Jul 20, 2025 | Low-level laser therapy may be considered medically necessary for prevention of oral mucositis in patients... | Ver |
| 08.001.011 | Manipulation Under Anesthesia | May 20, 2024 | May 20, 2025 | Spinal manipulation and manipulation of other joints performed during the procedure (eg, hip joint) with the... | Ver |
| 08.001.030 | OCCUPATIONAL THERAPY | Jan 29, 2020 | Policy Archived | Occupational therapy services are considered for payment when they are performed to address the need of a... | Ver |
| 08.001.035 | Aquatic Therapy | Nov 11, 2020 | Policy Archived | Aquatic therapy to improve or restore physical function after illness, trauma or physical damage or loss of... | Ver |
| 08.001.050 | Hematopoietic Cell Transplantation for Acute Myeloid Leukemia | Feb 20, 2024 | Feb 20, 2025 | Allogeneic hematopoietic cell transplantation (hct) using a myeloablative conditioning regimen may be... | Ver |
