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 |
|---|---|---|---|---|---|
| 11.001.039 | Nutrient/Nutritional Panel Testing | Jan 08, 2024 | Jan 20, 2025 | Nutrient/nutritional panel testing is considered investigational for all indications including but not... | Ver |
| 11.001.040 | Testing Serum Vitamin D Levels | Jan 15, 2024 | Jan 20, 2025 | Testing vitamin d levels in individuals with signs and/or symptoms of vitamin d deficiency or toxicity (see... | Ver |
| 11.001.041 | Drug Testing in Pain Management and Substance Use Disorder Treatment | Dec 11, 2023 | Dec 20, 2024 | In outpatient pain management, presumptive (i.e. immunoassay) drug testing may be considered medically... | Ver |
| 11.001.042 | Fecal Calprotectin Testing | Jan 04, 2024 | Jan 20, 2025 | Fecal calprotectin testing may be considered medically necessary for the evaluation of individuals when the... | Ver |
| 11.001.044 | Antigen Leukocyte Antibody Test | Nov 15, 2023 | Nov 20, 2024 | The antigen leukocyte antibody test is considered investigational for all... | Ver |
| 11.001.046 | Maternal Serum Biomarkers for Prediction of Adverse Obstetric Outcomes | Mar 20, 2023 | Mar 20, 2024 | The use of maternal serum biomarker tests with or without additional algorithmic analysis for prediction of... | Ver |
| 11.001.047 | Multicancer Early Detection Testing | Jul 18, 2023 | Policy Archived | The use of multicancer early detection (mced) tests (e.g., galleri) is considered investigational for cancer... | Ver |
| 11.002.001 | Systems Pathology in Prostate Cancer | Dec 10, 2020 | Policy Archived | Use of tests utilizing systems pathology that include cellular and biologic features of a tumor is considered... | Ver |
| 11.002.003 | Molecular Testing for the Management of Pancreatic Cysts, Barrett Esophagus, and Solid Pancreaticobiliary Lesions | Aug 16, 2023 | Aug 20, 2024 | Molecular testing using the pathfindertg system is considered investigational for all indications including... | Ver |
| 11.002.004 | Cervical Cancer Screening Technologies With Pap and HPV | Apr 28, 2022 | Policy Archived | The following refers to average-risk asymptomatic women aged 21 to 65: preparation of papanicolaou (pap)... | Ver |
| 11.003.001 | Laboratory Tests Post Transplant and for Heart Failure | Nov 16, 2023 | Nov 20, 2024 | The use of the presage st2 assay to evaluate the prognosis of individuals diagnosed with chronic heart... | Ver |
| 11.003.002 | Genetic Testing for Predisposition to Inherited Hypertrophic Cardiomyopathy | Apr 12, 2023 | Apr 20, 2024 | Genetic testing for predisposition to hypertrophic cardiomyopathy may be considered medically necessary for... | Ver |
| 11.003.003 | Multimarker Serum Testing Related to Ovarian Cancer | Jan 19, 2024 | Jan 20, 2025 | All uses of the ova1, overa, and roma tests are investigational, including but not limited to:... | Ver |
| 11.003.004 | Somatic Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment in Metastatic Colorectal Cancer (KRAS, NRAS, BRAF, and HER2) | Aug 17, 2023 | Aug 20, 2024 | Kras, nras, braf, or her2 testing of tumor tissue may be considered medically necessary for individuals with... | Ver |
| 11.003.006 | PRUEBAS GENETICAS PARA EL TRATAMIENTO HELICOBACTER PYLORI | May 12, 2016 | Policy Archived | La prueba genética para determinar polimorfismo en sistema enzimático citocromo p450 (cyp2c19) no procede... | Ver |
| 11.003.008 | Cytochrome P450 Genotype-Guided Treatment Strategy | Jul 11, 2023 | Jul 20, 2024 | Cytochrome p450 (cyp450) genotyping for the purpose of aiding in the choice of clopidogrel versus... | Ver |
| 11.003.009 | Somatic Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment in Non-Small-Cell Lung Cancer (EGFR, ALK, BRAF, ROS1, RET, MET, KRAS) | Dec 04, 2023 | Dec 20, 2024 | Egfr testing analysis of tumor tissue for somatic variants in exons 18 through 21 (eg, g719x, l858r,... | Ver |
| 11.003.010 | Genetic Testing of CADASIL Syndrome | May 08, 2023 | May 20, 2024 | Genetic testing for a notch3 variant to confirm the diagnosis of cerebral autosomal dominant arteriopathy... | Ver |
| 11.003.011 | Somatic Genetic Testing to Select Individuals with Melanoma or Glioma for Targeted Therapy (BRAF) | Aug 15, 2023 | Aug 20, 2024 | Testing for braf v600 variants in tumor tissue of individuals with unresectable or metastatic melanoma, or... | Ver |
| 11.003.012 | Genetic Testing for Inherited Thrombophilia | Jun 07, 2023 | Jun 20, 2024 | Genetic testing for inherited thrombophilia, including testing for the factor v leiden variant, prothrombin... | Ver |
