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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 |
|---|---|---|---|---|---|
| 07.003.012 | Amniotic Membrane and Amniotic Fluid | Apr 19, 2024 | Apr 20, 2025 | Treatment of nonhealing diabetic lower-extremity ulcers using the following human amniotic membrane products... | Ver |
| 07.003.013 | Composite Tissue Allotransplantation of the Hand and Face | Sep 12, 2024 | Sep 20, 2025 | Composite tissue allotransplantation (also referred to as vascularized composite allotransplantation) is... | Ver |
| 07.003.014 | Kidney Transplant | Sep 12, 2024 | Sep 20, 2025 | Kidney transplants with either a living or cadaver donor may be considered medically necessary for carefully... | Ver |
| 07.004.001 | Implantation of Intrastromal Corneal Ring Segments | May 17, 2021 | Policy Archived | Implantation of intrastromal corneal ring segments may be considered medically necessary for the treatment of... | Ver |
| 07.004.002 | Vascular Endothelial Growth Factor Inhibitors for the Treatment of Ophthalmological Diseases | Oct 24, 2024 | Oct 20, 2025 | Intravitreal bevacizumab (avastin) intravitreal bevacizumab (avastin) injections is considered medically... | Ver |
| 08.001.001 | Physical Therapy in the home | Nov 11, 2020 | Policy Archived | Physical therapy in the home is considered for payment if it meets the following criteria: a. prior to... | Ver |
| 08.001.002 | Physical Therapy Services | Nov 26, 2024 | Policy Archived | However, not all studies have found a benefit for mld over standard management for reducing limb volume... | Ver |
| 08.001.003 | HOME BASED OCCUPATIONAL THERAPY | Nov 11, 2020 | Policy Archived | Occupational therapy services home based are considered for payment when performed to address the need for a... | Ver |
| 08.001.004 | Speech Therapy | Nov 26, 2024 | Policy Archived | Speech therapy services are considered for payment when: • they are prescribed or recommended by a... | Ver |
| 08.001.005 | Photodynamic Therapy for Choroidal Neovascularization | May 06, 2024 | Apr 20, 2025 | Verteporfin photodynamic therapy as monotherapy may be considered medically necessary as a treatment of... | Ver |
| 08.001.006 | Vertebral Axial Decompression | May 20, 2024 | May 20, 2025 | Vertebral axial decompression is considered... | Ver |
| 08.001.007 | Dry Needling of Trigger Points for Myofascial Pain | May 20, 2024 | May 20, 2025 | Dry needling of trigger points for the treatment of myofascial pain is considered investigational.... | Ver |
| 08.001.008 | Oncologic Applications of Photodynamic Therapy, Including Barrett Esophagus | Aug 12, 2024 | Aug 20, 2025 | One or more courses of photodynamic therapy may be considered medically necessary for the following... | 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 |
| 08.001.010 | High-Dose Rate Temporary Prostate Brachytherapy | Aug 13, 2024 | Aug 20, 2025 | High-dose rate prostate brachytherapy may be considered medically necessary as monotherapy or in... | Ver |
| 08.001.011 | Manipulation Under Anesthesia | May 20, 2024 | May 20, 2025 | Manipulation under anesthesia consists of a series of mobilization, stretching, and traction procedures... | Ver |
| 08.001.012 | Charged-Particle (Proton or Helium Ion) Radiotherapy for Neoplastic Conditions | Jun 10, 2024 | Jun 20, 2025 | Charged-particle irradiation with proton or helium ion beams may be considered medically necessary for... | Ver |
| 08.001.013 | Interferon Therapy | Jun 06, 2022 | Policy Archived | The use of recombinant or natural interferon alfa for the treatment of hematologic malignancies (lymphomas,... | Ver |
| 08.001.014 | Chelation Therapy for Off-Label Uses | Mar 19, 2024 | Mar 20, 2025 | Off-label applications of chelation therapy (see policy guidelines section for uses approved by the u.s. food... | Ver |
| 08.001.015 | Inhaled Nitric Oxide | Jun 11, 2024 | Jun 20, 2025 | Inhaled nitric oxide may be considered medically necessary as a component of treatment of: hypoxic... | Ver |
