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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 |
|---|---|---|---|---|---|
| 08.001.053 | Chimeric Antigen Receptor Therapy for Leukemia and Lymphoma | Jan 08, 2024 | Jan 20, 2025 | Tisagenlecleucel for b-cell acute lymphoblastic leukemia tisagenlecleucel is considered medically... | Ver |
| 10.002.001 | CHIROPRACTIC SERVICES | Feb 25, 2022 | Policy Archived | Chiropractic services may be considered medically necessary when all of the following criteria are met:... | Ver |
| 10.002.006 | OSTEOPATHY DOCTORS’ SERVICES | Jul 13, 2022 | Policy Archived | The doctor in osteopathy is authorized to practice osteopathy by the medical licensing and discipline board... | Ver |
| 10.002.010 | Acupuncture | Apr 20, 2022 | Policy Archived | Acupuncture may be considered medically necessary for treatment of the following conditions: 1. chronic... | Ver |
| 11.001.001 | Autologous blood transfusion (Cell Saver) | Sep 29, 2022 | Policy Archived | The self-transfusion "cell savers" is considered for payment in the following surgeries: a. general... | Ver |
| 11.001.007 | Identification of Microorganisms Using Nucleic Acid Probes | Jul 16, 2024 | Jul 20, 2025 | The use of nucleic acid testing using a direct or amplified probe technique (without quantification of viral... | Ver |
| 11.003.008 | Cytochrome P450 Genotype-Guided Treatment Strategy | Jul 17, 2024 | Jul 20, 2025 | Cytochrome p450 (cyp450) genotyping for the purpose of aiding in the choice of clopidogrel versus... | Ver |
| 11.003.013 | Genetic Testing for Rett Syndrome | Jun 07, 2024 | Jun 20, 2025 | Genetic testing for rett syndrome-associated genes (eg, mecp2, foxg1, or cdkl5) may be considered medically... | Ver |
| 11.003.025 | Genetic Testing for Developmental Delay/Intellectual Disability, Autism Spectrum Disorder, and Congenital Anomalies | Nov 16, 2023 | Nov 20, 2024 | Chromosomal microarray analysis may be considered medically necessary as first-line testing in the initial... | Ver |
| 11.003.028 | Genetic Testing for Lynch Syndrome and Other Inherited Colon Cancer Syndromes | Oct 11, 2023 | Oct 20, 2024 | Apc testing genetic testing of the apc gene may be considered medically necessary in the following... | Ver |
| 11.003.034 | Genetic and Protein Biomarkers for the Diagnosis and Cancer Risk Assessment of Prostate Cancer | Dec 20, 2023 | Dec 20, 2024 | The following genetic and protein biomarkers for the diagnosis of prostate cancer are... | Ver |
| 11.003.035 | Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis in Patients with Breast Cancer | Dec 06, 2023 | Dec 20, 2024 | The use of the 21-gene reverse transcriptase-polymerase chain reaction (rt-pcr) assay (ie, oncotype dx),... | Ver |
| 11.003.066 | Genetic Testing for Duchenne and Becker Muscular Dystrophy | Apr 17, 2024 | Apr 20, 2025 | Genetic testing for dmd gene variants may be considered medically necessary under the following conditions:... | Ver |
| 11.003.072 | Genetic Testing for Marfan Syndrome, Thoracic Aortic Aneurysms and Dissections, and Related Disorders | Apr 19, 2024 | Apr 20, 2025 | Individual genetic testing for the diagnosis of marfan syndrome, ehlers-danlos syndrome type iv, other... | Ver |
| 11.003.079 | Invasive Prenatal (Fetal) Diagnostic Testing | Sep 07, 2023 | Sep 20, 2024 | Chromosomal microarray testing in patients who are undergoing invasive diagnostic prenatal (fetal)... | Ver |
| 11.003.130 | Acupuncture for Pain Management, Nausea and Vomiting, and Opioid Dependence | Dec 14, 2023 | Dec 20, 2024 | Acupuncture may be considered medically necessary for treatment of episodic migraines and/or tension-type... | Ver |
| M5.001.001 | Viscosupplementation Therapy For Knee | May 10, 2024 | Oct 20, 2024 | Viscosupplementation therapy is part of the therapy used in the treatment of osteoarthritis of the knee.... | Ver |
| M5.001.002 | Rituximab | May 10, 2024 | Oct 20, 2024 | Rituximab is a genetically engineered chimeric murine/human monoclonal igg1 kappa antibody directed against... | Ver |
| M5.001.003 | Trastuzumab – Trastuzumab Biologics | May 10, 2024 | Oct 20, 2024 | Trastuzumab is a monoclonal antibody, one of a group of drugs designed to attack specific cancer cells.... | Ver |
| M5.001.004 | Pegfilgrastim | Oct 26, 2023 | Retired | Pegfilgrastim is a colony stimulating factor (csf) that acts on hematopoietic cells by binding to specific... | Ver |
