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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
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 06, 2023 Jun 20, 2024 Inhaled nitric oxide may be considered medically necessary as a component of treatment of: hypoxic... Ver
08.001.016 Extracorporeal Photopheresis Nov 15, 2023 Nov 20, 2024 Organ rejection after solid organ transplant extracorporeal photopheresis may be considered medically... Ver
08.001.017 Accelerated Breast Irradiation and Brachytherapy Boost After Breast-Conserving Surgery for Early-Stage Breast Cancer Aug 16, 2023 Aug 20, 2024 When using radiotherapy after breast-conserving surgery for early-stage breast cancer: accelerated... Ver
08.001.019 Measurement of Exhaled Nitric Oxide and Exhaled Breath Condensate in the Diagnosis and Management of Respiratory Disorders Jul 05, 2023 Jul 20, 2024 Measurement of exhaled nitric oxide is considered investigational in the diagnosis and management of... Ver
08.001.020 Neutron Beam Radiotherapy May 10, 2019 Policy Archived Neutron beam radiotherapy of advanced salivary gland tumors and soft tissue sarcomas is considered medically... Ver
08.001.021 Scintimammography and Gamma Imaging of the Breast and Axilla Oct 19, 2023 Oct 20, 2024 Scintimammography, breast-specific gamma imaging, and molecular breast imaging are... Ver
08.001.022 Intracavitary Balloon Catheter Brain Brachytherapy for Malignant Gliomas or Metastasis to the Brain Aug 09, 2023 Aug 20, 2024 Intracavitary balloon catheter brain brachytherapy is considered investigational,alone or as part of a... Ver
08.001.023 ERWINAZE Nov 10, 2021 Policy Archived Erwinaze is considered for payment in the treatment of acute lymphocytic leukemia and acute myeloid leukemia... Ver
08.001.024 CORRECCION DE LOS TRASTORNOS DE LA REFRACCION May 22, 2017 Policy Archived Corrección de trastornos de la visión no proceden para pago irrespectivo de la técnica o modalidad... Ver
08.001.025 Adoptive Immunotherapy Nov 13, 2023 Nov 20, 2024 All adoptive immunotherapy techniques intended to enhance autoimmune effects are... Ver
08.001.027 Cellular Immunotherapy for Prostate Cancer Aug 15, 2023 Aug 20, 2024 Sipuleucel-t therapy may be considered medically necessary in the treatment of asymptomatic or minimally... Ver
08.001.028 Lysis of Epidural Adhesions Dec 29, 2020 Dec 29, 2021 Catheter-based techniques for lysis of epidural adhesions, with or without endoscopic guidance, are... Ver
08.001.029 Pneumatic Compression Pumps for Treatment of Lymphedema and Venous Ulcers Apr 09, 2024 Apr 20, 2025 Single-compartment or multichamber nonprogrammable lymphedema pumps applied to the limb may be... 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
08.001.031 Chemical Peels Jan 12, 2024 Jan 20, 2025 Dermal chemical peels used to treat individuals with numerous (>10) actinic keratoses or other premalignant... Ver
08.001.033 Hematopoietic Cell Transplantation for Plasma Cell Dyscrasias, Including Multiple Myeloma and POEMS Syndrome Feb 08, 2024 Feb 20, 2025 Multiple myeloma a single or second (salvage) autologous hematopoietic cell transplantation may be... Ver
08.001.034  DYSPHAGIA THERAPY  Feb 14, 2024 Oct 20, 2024 Therapy for the treatment of dysphagia is considered medically necessary and proceeds for payment when any... 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

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