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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 |
|---|---|---|---|---|---|
| 11.003.037 | Biomarker Testing in Risk Assessment and Management of Cardiovascular Disease | Jan 20, 2025 | Jan 20, 2026 | Measurement of nontraditional lipid and non-lipid biomarkers (ie, apolipoprotein b, apolipoprotein ai,... | Ver |
| 11.003.038 | Biomarker Genes for Detection of Lymph Node metastases in Breast Cancer | May 15, 2019 | Policy Archived | Evaluation of biomarker genes is considered investigational for detection of lymph node metastases in... | Ver |
| 11.003.039 | Pharmacogenomic and Metabolite Markers for Patients Treated With Thiopurines | Dec 20, 2024 | Dec 20, 2025 | One time genotypic or phenotypic analysis of thiopurine methyltransferase (tpmt) and nudix hydrolase (nudt15)... | Ver |
| 11.003.040 | Genetic Testing for Alzheimer Disease | Nov 22, 2024 | Nov 20, 2025 | Targeted genetic testing for a known familial variant in the presenilin (psen) genes or amyloid-beta... | Ver |
| 11.003.042 | Genetic Testing for Cardiac Ion Channelopathies | Feb 13, 2024 | Feb 20, 2025 | Long qt syndrome genetic testing to confirm a diagnosis of congenital long qt syndrome (lqts) may be... | Ver |
| 11.003.046 | Genetic Testing for FMR1 Variants (Including Fragile X Syndrome) | Nov 26, 2024 | Feb 20, 2025 | Genetic testing for fragile x mental retardation 1 gene (fmr1) variants may be considered medically... | Ver |
| 11.003.047 | Gene Expression-Based Assays for Cancers of Unknown Primary | Apr 15, 2024 | Apr 20, 2025 | Gene expression profiling is considered investigational to evaluate the site of origin of a tumor of unknown... | Ver |
| 11.003.048 | Carrier Screening for Genetic Diseases | Oct 10, 2024 | Oct 20, 2025 | Targeted risk-based carrier screening targeted carrier screening for x-linked and autosomal recessive... | Ver |
| 11.003.049 | Genetic Testing for Diagnosis and Management of Mental Health Conditions | Aug 20, 2024 | Aug 20, 2025 | Genetic testing for diagnosis and management of mental health disorders is considered investigational in... | Ver |
| 11.003.050 | Genetic Testing for Epilepsy | Mar 11, 2024 | Mar 20, 2025 | Epilepsy is a disorder characterized by unprovoked seizures. it is a heterogeneous condition that encompasses... | Ver |
| 11.003.051 | Gene Expression Profiling and Protein Biomarkers for Prostate Cancer Management | Oct 08, 2024 | Oct 20, 2025 | Use of gene expression analysis and protein biomarkers to guide management of prostate cancer is considered... | Ver |
| 11.003.052 | Gene Expression Profiling and Protein Biomarkers for Prostate Cancer Managementt | Sep 24, 2024 | Sep 20, 2025 | For individuals who have thyroid nodules without strong clinical or radiologic findings suggestive of... | Ver |
| 11.003.053 | Whole Exome and Whole Genome Sequencing for Diagnosis of Genetic Disorders | Apr 18, 2024 | Apr 20, 2025 | Standard whole exome sequencing, with trio testing when possible (see policy guidelines), may be considered... | Ver |
| 11.003.056 | Genetic Testing for a Thalassemia | Jul 10, 2024 | Jul 20, 2025 | Genetic testing to confirm a diagnosis of α-thalassemia is considered investigational. genetic testing... | Ver |
| 11.003.057 | Genetic Testing for Fanconi Anemia | Jan 15, 2025 | Jan 20, 2026 | Genetic testing for the diagnosis of fanconi anemia may be considered medically necessary when the... | Ver |
| 11.003.059 | Genetic Testing for Hereditary Pancreatitis | Mar 11, 2024 | Mar 20, 2025 | In chronic pancreatitis (cp), recurrent attacks of acute pancreatitis evolve into a chronic inflammatory... | Ver |
| 11.003.060 | Genetic Testing for FLT3, NPM1, and CEBPA Variants in Cytogenetically Normal Acute Myeloid Leukemia | Feb 20, 2024 | Feb 20, 2025 | Treatment of acute myeloid leukemia (aml) is based on risk stratification, primarily related to patient age... | Ver |
| 11.003.062 | General Approach to Genetic Testing | Jan 21, 2025 | Jan 20, 2026 | Genetic testing classified in one of the categories below may be considered medically necessary when all... | Ver |
| 11.003.063 | BCR-ABL1 Testing in Chronic Myelogenous Leukemia and Acute Lymphoblastic Leukemia | Dec 03, 2024 | Nov 20, 2025 | Chronic myelogenous leukemia bcr-abl1 qualitative testing for the presence of the fusion gene may be... | Ver |
| 11.003.064 | Genetic Cancer Susceptibility Panels Using Next Generation Sequencing | Dec 12, 2024 | Nov 20, 2025 | General genetic cancer susceptibility panel testing is considered investigational; however, when the... | Ver |
