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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
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 26, 2023 Oct 20, 2024 1.a history of a surgical code will limit for payment the approval of a second surgical code in a same... Ver
13.004.002 Periodontal non-Surgical Services Oct 26, 2023 Oct 20, 2024 All periodontal treatments need predetermination of benefits and the treatment plan for evaluation, should be... Ver
13.005.001 Dental Implants Oct 26, 2023 Oct 20, 2024 1. there must be bone integration of the implant, to be able move to the prosthesis phase of crowns,... Ver
13.005.002 Implant Services; Crowns, bridges (retainers and Pontics) and Prostheses Supported by Implants Oct 26, 2023 Oct 20, 2024 1. crowns should be predetermined and are subject to the corresponding coinsurances and caps. 2. the... Ver
13.006.001 Visit to Ambulatory Surgical Center and / or Hospital Nov 11, 2020 Policy Archived Code d9420 requires predeterminationand the required documents are; (a) patient’s diagnostic (b)... Ver
13.007.001 Maxillofacial Prosthesis Oct 26, 2023 Oct 20, 2024 The maxillofacial prosthesis services require predetermination. 1. the maxillofacial prosthesis services... Ver
13.008.001 Frenectomy Oct 26, 2023 Policy Archived 1.requires predetermination. 2.the predetermination must be accompanied by the evaluation and... Ver
13.009.001 Maxillary Obturators Aug 22, 2023 Policy Archived These services are covered for all patients that have a palatal or nasopharyngeal defect that impairs the... Ver
13.009.002 Oral Surgical Splint, Impression and Preparation Nov 11, 2020 Policy Archived This service is considered as surgical guidance and stabilization for orthognathic surgery (surgical... Ver
13.009.003 Orthognathic Surgery Oct 26, 2023 Oct 20, 2024 These surgeries may be recognized for payment as long as one of the following criteria is met:... Ver
13.009.004 Temporomandibular Joint Disorder Mar 15, 2023 Mar 15, 2024 Diagnostic procedures the following diagnostic procedures may be considered medically necessary in the... Ver
13.010.001 Orthodontic Services Oct 26, 2023 Oct 20, 2024 1. that sufficient functional disability be present as a result of disease, trauma, congenital anomalies... Ver
7.001.168 Surgical Left Atrial Appendage Occlusion Devices for Stroke Prevention in Atrial Fibrillation Sep 07, 2022 Sep 07, 2023 The use of surgical left atrial appendage occlusion devices, including the atriclip device, for stroke... Ver
M5.001.001 Viscosupplementation Therapy For Knee Oct 26, 2023 Oct 20, 2024 Viscosupplementation therapy is part of the therapy used in the treatment of osteoarthritis of the knee.... Ver
M5.001.002 Rituximab Oct 26, 2023 Oct 20, 2024 Rituximab is a genetically engineered chimeric murine/human monoclonal igg1 kappa antibody directed against... Ver
M5.001.003 Trastuzumab – Trastuzumab Biologics Oct 26, 2023 Oct 20, 2024 Trastuzumab is a monoclonal antibody, one of a group of drugs designed to attack specific cancer cells.... Ver
M5.001.004 Pegfilgrastim  Sep 20, 2023 Oct 26, 2023 Pegfilgrastim is a colony stimulating factor (csf) that acts on hematopoietic cells by binding to specific... Ver
M5.001.005 Bevacizumab – Bevacizumab Biologics for Oncologic Uses Oct 26, 2023 Oct 20, 2024 Bevacizumab is a humanized monoclonal antibody directed against vascular endothelial growth factor a... Ver
M5.001.006 CSF Hematopoietic Colony Stimulating Factors Oct 26, 2023 Oct 20, 2024 G-csf is classified as a recombinant hematopoietic stimulant. this is not a cancer chemotherapy agent. it is... Ver

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