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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
07.001.110 Blepharoplasty Nov 09, 2022 Policy Archived Blepharoplasty or blepharoplasty repair is covered for payment if the following conditions are met: 1.... Ver
07.001.112 Ablation of Peripheral Nerves to Treat Pain Oct 10, 2024 Oct 20, 2025 Radiofrequency ablation (rfa) and cryoneurolysis of nerves have been proposed as treatments for several... Ver
07.001.114 Bioengineered Skin and Soft Tissue Substitutes Dec 12, 2024 May 20, 2025 Breast reconstructive surgery using allogeneic acellular dermal matrix productsa (including each of the... Ver
07.001.115 Vertical Expandable Prosthetic Titanium Rib May 20, 2024 May 20, 2025 Use of the vertical expandable prosthetic titanium rib is considered medically necessary in the treatment... Ver
07.001.116 ROUTINE CARE SERVICES OF THE FOOT Nov 09, 2022 Policy Archived Triple-s considers for routine foot care services when: · the provider has the proper qualifications.... Ver
07.001.117 Minimally Invasive Ablation Procedures for Morton and Other Peripheral Neuromas Jul 18, 2024 Jul 20, 2025 Minimally invasive ablation procedures, including intralesional alcohol injection, radiofrequency ablation,... Ver
07.001.118 Percutaneous Electrical Nerve Stimulation, Percutaneous Neuromodulation Therapy, and Restorative Neurostimulation Therapy Jul 17, 2024 Jul 20, 2025 Percutaneous electrical nerve stimulation (pens), percutaneous neuromodulation therapy (pnt), and restorative... Ver
07.001.119 Surgical Treatments for Breast Cancer-Related Lymphedema Oct 10, 2024 Oct 20, 2025 Lymphatic physiologic microsurgery to treat lymphedema (including, but not limited to, lymphatico-lymphatic... Ver
07.001.120 Facet Arthroplasty May 16, 2024 May 20, 2025 Total facet arthroplasty in individuals with lumbar spinal stenosis undergoing spinal decompression is... Ver
07.001.121 Absorbable Nasal Implant for Treatment of Nasal Valve Collapse Nov 14, 2024 Nov 20, 2025 The insertion of an absorbable lateral nasal implant for the treatment of symptomatic nasal valve collapse is... Ver
07.001.122 Adipose-Derived Stem Cells in Autologous Fat Grafting to the Breast Feb 12, 2024 Feb 20, 2025 Following a mastectomy, patients often experience pain and irradiated skin; as an adjunct to reconstructive... Ver
07.001.123 Hydrogel Spacer use During Radiotherapy for Prostate Cancer Oct 24, 2024 Oct 24, 2025 Hydrogel spacer use radiotherapy for prostate cancer may be considered medically necessary in individuals... Ver
07.001.124 Semi-Implantable and Fully Implantable Middle Ear Hearing Aids Mar 07, 2024 Mar 20, 2025 Semi-implantable and fully implantable middle ear hearing aids are... Ver
07.001.125 Surgical Deactivation of Headache Trigger Sites Mar 07, 2024 Mar 20, 2025 Surgical deactivation of trigger sites is considered investigational for the treatment of migraine and... Ver
07.001.126 Handheld Radiofrequency Spectroscopy for Intraoperative Assessment of Surgical Margins During Breast-Conserving Surgery Mar 07, 2024 Mar 20, 2025 Handheld radiofrequency spectroscopy for intraoperative assessment of surgical margins during... Ver
07.001.127 Surgery for Groin Pain in Athletes Mar 07, 2024 Mar 20, 2025 Surgical treatment of groin pain in athletes (also known as athletic pubalgia, gilmore groin, osteitis pubis,... Ver
07.001.128 Balloon Dilation of the Eustachian Tube Oct 07, 2024 Oct 20, 2025 Balloon dilation of the eustachian tube (bdet) for treatment of chronic obstructive eustachian tube... Ver
07.001.129 Synthetic Cartilage Implants for Joint Pain Aug 09, 2024 Aug 20, 2025 Synthetic cartilage implants are considered investigational for the treatment of articular cartilage... Ver
07.001.132 RHINOPLASTY Nov 10, 2021 Policy Archived Rhinoplasty rhinoplasty may be considered for payment only in the following limited situations:... Ver
07.001.133 Radiofrequency Coblation Tenotomy for Musculoskeletal Conditions Jan 17, 2025 Jan 20, 2026 Radiofrequency coblation tenotomy is considered investigational as a treatment for musculoskeletal... Ver

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