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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 |
|---|---|---|---|---|---|
| 11.003.089 | Circulating Tumor DNA and Circulating Tumor Cells for Cancer Management (Liquid Biopsy) | Sep 20, 2024 | Sep 20, 2025 | The use of circulating tumor dna and/or circulating tumor cells is considered investigational for all... | Ver |
| 11.003.090 | RATIONALE | Mar 15, 2024 | Mar 20, 2025 | Gene expression profiling for uveal melanoma with decisiondx-um is medically necessary for patients with... | Ver |
| 11.003.092 | Proteogenomic Testing for Patients With Cancer | Jul 08, 2024 | Jul 20, 2025 | Proteogenomic testing (see policy guidelines section) of individuals with cancer (including, but not limited... | Ver |
| 11.003.093 | Genetic Testing for Mitochondrial Disorders | Oct 08, 2024 | Oct 20, 2025 | Genetic testing to establish a genetic diagnosis of a mitochondrial disorder may be considered medically... | Ver |
| 11.003.094 | Serum Biomarker Panel Testing for Systemic Lupus Erythematosus and Other Connective Tissue Diseases | Jul 08, 2024 | Jul 20, 2025 | Serum biomarker panel testing with proprietary algorithms and/or index scores for the diagnosis of systemic... | Ver |
| 11.003.095 | Genotype-Guided Tamoxifen Treatment | Sep 13, 2024 | Sep 20, 2025 | Genotyping to determine cytochrome p450 2d6 (cyp2d6) variants is considered investigational for the purpose... | Ver |
| 11.003.096 | Miscellaneous Genetic and Molecular Diagnostic Tests | Aug 12, 2024 | Aug 20, 2025 | All tests listed in this policy are considered investigational and grouped according to the categories of... | Ver |
| 11.003.097 | Gene Expression Profiling for Cutaneous Melanoma | Jun 07, 2024 | Jun 20, 2025 | Gene expression testing, including but not limited to the pigmented lesion assay, in the evaluation of... | Ver |
| 11.003.098 | Use of Common Genetic Variants (Single Nucleotide Variants) to Predict Risk of Nonfamilial Breast Cancer | Nov 15, 2024 | Nov 20, 2025 | Testing for 1 or more single nucleotide variants to predict an individual’s risk of breast cancer is... | Ver |
| 11.003.099 | Circulating Tumor DNA for Management of Non-Small-Cell Lung Cancer (Liquid Biopsy) | Dec 10, 2021 | Policy Archived | Proteomic testing has been proposed as a way to predict survival outcomes, as well as the response to and... | Ver |
| 11.003.100 | DNA-Based Testing for Adolescent Idiopathic Scoliosis | Mar 05, 2021 | Policy Archived | Dna-based prognostic testing for adolescent idiopathic scoliosis is... | Ver |
| 11.003.101 | Genetic Testing for Alpha 1 – Antitrypsin Deficiency | Feb 13, 2024 | Feb 20, 2025 | Genetic testing for alpha1-antitrypsin deficiency may be considered medically necessary when either of the... | Ver |
| 11.003.102 | Genetic Testing for Neurofibromatosis | Feb 05, 2025 | Feb 20, 2026 | Genetic testing for neurofibromatosis type 1 (nf1) or neurofibromatosis type 2 (nf2) pathogenic variants... | Ver |
| 11.003.103 | Gene Therapy for Inherited Retinal Dystrophy | Feb 13, 2024 | Feb 20, 2025 | Adeno-associated virus vector-based gene therapy via subretinal injection with voretigene neparvovec is... | Ver |
| 11.003.104 | Genetic Testing for Lipoprotein(a) Variant(s) as a Decision Aid for Aspirin Treatment | Dec 28, 2021 | Policy Archived | Lipoprotein(a) (lpa) is a lipid-rich particle similar to low-density lipoprotein and has been determined to... | Ver |
| 11.003.105 | Microarray-Based Gene Expression Profile Testing for Multiple Myeloma Risk Stratification | Dec 05, 2024 | Nov 20, 2025 | Microarray-based gene expression profile testing for multiple myeloma is considered investigational for all... | Ver |
| 11.003.106 | Genetic Testing for Heterozygous Familial Hypercholesterolemia | Nov 12, 2024 | Nov 20, 2025 | Genetic testing to confirm a diagnosis of familial hypercholesterolemia (fh) may be considered medically... | Ver |
| 11.003.107 | Germline Genetic Testing for Pancreatic Cancer Susceptibility Genes (ATM, BRCA1, BRCA2, CDKN2A, EPCAM, MLH1, MSH2, MSH6, PALB2, PMS2, STK11, and TP53) | Dec 16, 2024 | Mar 20, 2025 | Genetic testing for brca1, brca2, and palb2 variants to guide selection for treatment with platinum-based... | Ver |
| 11.003.108 | Measurement of Serum Antibodies to Selected Biologic Agent | Dec 20, 2024 | Dec 20, 2025 | Measurement of antidrug antibodies in an individual receiving treatment with a biologic agent, either alone... | Ver |
| 11.003.109 | Human Leukocyte Antigen Testing for Celiac Disease | Dec 09, 2024 | Dec 20, 2025 | Hla-dq2 and hla-dq8 testing may be considered medically necessary to rule out celiac disease in: patients... | Ver |
