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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 |
|---|---|---|---|---|---|
| 11.003.004 | Somatic Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment in Metastatic Colorectal Cancer (KRAS, NRAS, BRAF, and HER2) | Jul 17, 2024 | 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 17, 2024 | Jul 20, 2025 | 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) | Jul 22, 2024 | 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 16, 2024 | May 20, 2025 | 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) | Jul 19, 2024 | Jul 20, 2025 | Testing for braf v600 variants in individuals with unresectable or metastatic melanoma, or with resected... | Ver |
| 11.003.012 | Genetic Testing for Inherited Thrombophilia | Jun 18, 2024 | Jun 20, 2025 | Genetic testing for inherited thrombophilia, including testing for the factor v leiden variant, prothrombin... | 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 |
| 11.003.014 | Noninvasive Fetal RHD Genotyping Using Cell-Free Fetal DNA | Sep 07, 2023 | Sep 20, 2024 | Noninvasive fetal rhd genotyping using cell-free fetal dna is considered... | Ver |
| 11.003.015 | Gene Expression Profile Testing and Circulating Tumor DNA Testing for Predicting Recurrence in Colon Cancer | Sep 19, 2023 | Sep 20, 2024 | Gene expression assays for determining the prognosis of stage ii or iii colon cancer following surgery are... | Ver |
| 11.003.016 | Genetic Testing for PTEN Hamartoma Tumor Syndrome | Mar 08, 2024 | Mar 20, 2025 | Genetic testing for pten may be considered medically necessary to confirm the diagnosis when a patient has... | Ver |
| 11.003.017 | Genetic Testing for Hereditary Hearing Loss | May 12, 2024 | May 20, 2025 | Genetic testing for hereditary hearing loss genes (gjb2, gjb6, and other hereditary hearing loss–related... | Ver |
| 11.003.018 | Chromosomal Microarray Testing for the Evaluation of Pregnancy Loss | Sep 19, 2023 | Sep 20, 2024 | Chromosomal microarray testing of fetal tissue may be considered medically necessary for the evaluation of... | Ver |
| 11.003.020 | Genetic Testing for Lactase Insufficiency | Jun 13, 2024 | Jun 20, 2025 | The use of targeted mcm6 -13910c>t variant analysis for the prediction of lactase insufficiency is considered... | Ver |
| 11.003.021 | Gene Expression Testing in the Evaluation of Patients with Stable Ischemic Heart Disease | Apr 20, 2021 | Policy Archived | Gene expression testing in the evaluation of patients with stable ischemic heart disease is... | Ver |
| 11.003.022 | Genetic Testing for Li-Fraumeni Syndrome | Aug 16, 2023 | Aug 20, 2024 | Genetic testing for tp53 may be considered medically necessary to confirm a diagnosis of li-fraumeni syndrome... | Ver |
| 11.003.023 | General Approach to Evaluating the Utility of Genetic Panels | Jan 09, 2024 | Jan 20, 2025 | Genetic panels that use next-generation sequencing or chromosomal microarray analysis, and are classified in... | 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 |
| 11.003.026 | Comprehensive Genomic Profiling for Selecting Targeted Cancer Therapies | Nov 16, 2023 | Nov 20, 2024 | The use of comprehensive genomic profiling for selecting targeted cancer treatment is considered... | Ver |
| 11.003.027 | Germline Genetic Testing for Gene Variants Associated With Breast Cancer in Individuals at High Breast Cancer Risk (CHEK2, ATM, and BARD1) | Sep 13, 2023 | Sep 20, 2024 | Testing for chek2, atm, and bard1 variants in the assessment of breast cancer risk is considered... | Ver |
