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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 |
|---|---|---|---|---|---|
| 11.003.110 | Genetic Testing for Statin-Induced Myopathy | Dec 09, 2024 | Dec 20, 2025 | Genetic testing for the presence of variants in the slco1b1 gene to identify patients at risk of... | Ver |
| 11.003.111 | Next Generation Sequencing for the Assessment of Measurable Residual Disease | Jan 22, 2025 | Jan 20, 2026 | Next-generation sequencing (eg clonoseq) to detect measurable residual disease (mrd) at a threshold of... | Ver |
| 11.003.130 | Acupuncture for Pain Management, Nausea and Vomiting, and Opioid Dependence | Dec 16, 2024 | Dec 20, 2025 | Acupuncture may be considered medically necessary for treatment of episodic migraines and/or tension-type... | Ver |
| 11.003.131 | Sphenopalatine Ganglion Block for Headache | Dec 09, 2024 | Dec 20, 2025 | Chronic migraine and severe headaches are common conditions and the available treatments are not universally... | Ver |
| 11.003.133 | Serologic Genetic and molecular Screening for Colorectal Cancer | Aug 20, 2024 | Aug 20, 2025 | It is well established that early detection of colorectal cancer (crc) reduces disease-related mortality. for... | Ver |
| 11.003.134 | Molecular Testing for Germline Variants Associated with Ovarian Cancer (BRIP1, RAD51C, RAD51D, NBN) | Dec 16, 2024 | Sep 20, 2025 | Testing for germline brip1, rad51c, and rad51d variants for ovarian cancer risk assessment in adults may... | Ver |
| 11.003.135 | Germline and Somatic Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment in Breast Cancer (BRCA1, BRCA2, PIK3CA, Ki-67, RET, BRAF, ESR1, NTRK) | Jan 20, 2025 | Jan 20, 2026 | Brca1 and brca2 testing genetic testing for brca1 or brca2 germline variants may be... | Ver |
| 11.003.136 | Tumor-informed Circulating Tumor DNA Testing for Cancer Management | Oct 15, 2024 | Oct 20, 2025 | Tumor-informed circulating tumor dna testing (e.g., signatera) is considered investigational for all... | Ver |
| 11.003.137 | Germline Genetic Testing for Hereditary Diffuse Gastric Cancer (CDH1, CTNNA1) | Sep 20, 2024 | Sep 20, 2025 | Germline genetic testing for cdh1 variants to identify individuals with or at risk for hereditary diffuse... | Ver |
| 11.003.138 | Germline and Somatic Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment and Immunotherapy in Prostate Cancer (BRCA1/2, Homologous Recombination Repair Gene Alterations, NTRK Gene Fusion) | Oct 08, 2024 | Oct 20, 2025 | Biomarker-targeted therapy has shown a clear survival benefit in individuals with metastatic prostate cancer.... | Ver |
| 11.003.139 | Germline and Somatic Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment in Ovarian Cancer (BRCA1, BRCA2, Homologous Recombination Deficiency, NTRK) | Oct 16, 2024 | Oct 20, 2025 | Germline brca1/2 variant analysis may be considered medically necessary for individuals with advanced... | Ver |
| 11.003.140 | Somatic Biomarker Testing for Immune Checkpoint Inhibitor Therapy (BRAF, MSI/MMR, PD-L1, TMB) | May 12, 2024 | May 20, 2025 | Multiple biomarkers are being evaluated to predict response to immunotherapy for individuals with cancer.... | Ver |
| 11.003.141 | Laboratory Testing Investigational Services | Dec 05, 2024 | Nov 20, 2024 | All tests listed in this policy are considered investigational as there is insufficient evidence to determine... | Ver |
| 12.002.001 | Regional Anesthesia in Vaginal Birth | Mar 31, 2019 | Policy Archived | Local infiltration and pudendal blockade are considered part of the management of labor and are included in... | Ver |
| 13.001.001 | Restorative Single Crowns, Inlays and Onlays | Oct 26, 2023 | Policy Archived | Single crowns, inlays or onlays require predetermination and must be accompanied by periapical radiographic... | Ver |
| 13.002.001 | Removable Prostheses; Complete and Partial Removable Dentures | Oct 26, 2023 | Policy Archived | All removable dentures; complete or partial, require predetermination in the line of buisiness advantage... | Ver |
| 13.002.002 | Fixed Prosthesis | Oct 24, 2024 | Policy Archived | All fixed bridges require predetermination. please refer to the section of predetermination of benefits for... | Ver |
| 13.002.003 | Other Fixed Partial Dentures Services | Oct 26, 2023 | Policy Archived | Rules and limitations for other fixed partial dentures services: 1. code d6940 stress breaker and... | Ver |
| 13.003.001 | Endodontic Retreatment | Nov 11, 2020 | Policy Archived | If it is necessary to make a retreatment before 5 years, a predetermination is required and this must be... | Ver |
| 13.004.001 | Periodontal Surgical Services | Oct 24, 2024 | Oct 20, 2025 | 1.a history of a surgical code will limit for payment the approval of a second surgical code in a same... | Ver |
