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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
11.003.028 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
11.003.029 Epithelial Cell Cytology in Breast Cancer Risk Assesment and High-Risk Patient Management (Ductal Lavage and Suction Collection Systems) May 20, 2019 Policy Archived Cytologic analysis of epithelial cells from nipple aspirations as a technique to assess breast cancer risk... Ver
11.003.030 Germline Genetic Testing for Hereditary Breast/Ovarian Cancer Syndrome and Other High-Risk Cancers (BRCA1, BRCA2, PALB2) Sep 19, 2023 Sep 20, 2024 Genetic testing should be performed in a setting that has suitably trained health care providers who can give... Ver
11.003.031 Genetic Testing for Hereditary Hemochromatosis Jul 10, 2024 Policy Archived Genetic testing for human hemochromatosis (hfe) gene variants may be considered medically necessary in an... Ver
11.003.032 Analysis of Human DNA in Stool Samples as a Technique for Colorectal Cancer Screening Dec 20, 2023 Dec 20, 2024 Dna analysis of stool samples can be considered medically necessary as a screening technique for colorectal... Ver
11.003.033 ALISIS DE LOS PATRONES PROTEOMICOS PARA IDENTIFICACION TEMPRA DEL CÁNCER DE OVARIO May 12, 2016 Policy Archived El análisis de patrones proteómicos en el suero como cernimiento y detección de cáncer de ovario no se... 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
11.003.036 Genetic Testing for Familial Cutaneous Malignant Melanoma Apr 15, 2024 Apr 20, 2025 Genetic testing for genes associated with familial cutaneous malignant melanoma or associated with... Ver
11.003.037 Biomarker Testing in Risk Assessment and Management of Cardiovascular Disease Mar 19, 2024 Mar 20, 2025 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, 2023 Dec 20, 2024 One time genotypic or phenotypic analysis of thiopurine methyltransferase (tpmt) and nudix hydrolase (nudt15)... Ver
11.003.040 Genetic Testing for Alzheimer Disease Nov 16, 2023 Nov 20, 2024 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 X Syndrome) Feb 13, 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 18, 2023 Oct 20, 2024 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 17, 2023 Aug 20, 2024 Genetic testing for diagnosis and management of mental health disorders is considered investigational in... Ver
11.003.050 Genetic Testing for Epilepsy Mar 14, 2023 Mar 20, 2024 Genetic testing for genes associated with infantile- and early-childhood onset epilepsy syndromes in... Ver
11.003.051 Gene Expression Profiling and Protein Biomarkers for Prostate Cancer Management Dec 06, 2023 Dec 20, 2024 Use of gene expression analysis and protein biomarkers to guide management of prostate cancer is considered... Ver

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