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 |
|---|---|---|---|---|---|
| 11.003.108 | 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 | Oct 19, 2023 | May 20, 2024 | 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 |
| 11.003.140 | Somatic Biomarker Testing for Immune Checkpoint Inhibitor Therapy (BRAF, MSI/MMR, PD-L1, TMB) | May 24, 2023 | May 20, 2024 | Braf v600 variant testing braf v600 variant testing of tumor tissue to select individuals for immune... | Ver |
| 11.003.141 | Laboratory Testing Investigational Services | Nov 17, 2023 | 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 26, 2023 | Oct 20, 2024 | 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 |
