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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 |
|---|---|---|---|---|---|
| 11.003.101 | 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 09, 2024 | Feb 20, 2025 | 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 | The use of genetic testing for the lpa rs3798220 allele (lpa-aspirin genotype) is considered investigational... | Ver |
| 11.003.105 | Microarray-Based Gene Expression Profile Testing for Multiple Myeloma Risk Stratification | Nov 17, 2023 | Nov 20, 2024 | Microarray-based gene expression profile testing for multiple myeloma is considered investigational for all... | Ver |
| 11.003.106 | Genetic Testing for Heterozygous Familial Hypercholesterolemia | Feb 13, 2024 | Feb 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) | Mar 11, 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, 2023 | Dec 20, 2024 | 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 06, 2023 | Dec 20, 2024 | Hla-dq2 and hla-dq8 testing may be considered medically necessary to rule out celiac disease in: patients... | Ver |
| 11.003.110 | Genetic Testing for Statin-Induced Myopathy | Dec 07, 2023 | Dec 20, 2024 | 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 09, 2024 | Jan 20, 2025 | 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 14, 2023 | Dec 20, 2024 | 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 07, 2023 | Dec 20, 2024 | Sphenopalatine ganglion blocks are considered investigational for all indications, including but not limited... | Ver |
| 11.003.133 | Serologic Genetic and molecular Screening for Colorectal Cancer | Aug 17, 2023 | Aug 20, 2024 | Sept9 methylated dna testing (eg, colovantage®, epi procolon®) is considered investigational for colorectal... | Ver |
| 11.003.134 | Molecular Testing for Germline Variants Associated with Ovarian Cancer (BRIP1, RAD51C, RAD51D, NBN) | Sep 13, 2023 | Sep 20, 2024 | 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) | Jan 17, 2024 | Jan 20, 2024 | 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 | May 12, 2024 | May 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, 2023 | Sep 20, 2024 | 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) | Oct 11, 2023 | Oct 20, 2024 | Germline brca1/2 variant analysis for individuals with metastatic castrate-resistant prostate cancer (mcrpc)... | Ver |
| 11.003.139 | Germline and Somatic Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment in Ovarian Cancer (BRCA1, BRCA2, Homologous Recombination Deficiency) | Oct 11, 2023 | Oct 20, 2024 | Germline brca1/2 variant analysis may be considered medically necessary for individuals with advanced... | Ver |
