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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 |
|---|---|---|---|---|---|
| 02.001.053 | Ingestible pH and Pressure Capsule | Dec 28, 2020 | Policy Archived | Measurement of gastrointestinal transit times, including gastric emptying and colonic transit times, using an... | Ver |
| 02.001.054 | Alcohol Injections for Treatment of Peripheral Neuromas | Jul 08, 2023 | Policy Archived | Alcohol injections are considered investigational for treatment of morton... | Ver |
| 02.001.055 | Automated Point-of-Care Nerve Conduction Tests | Dec 08, 2020 | Policy Archived | Portable devices have been developed to provide point-of-care (poc) nerve conductions studies (ncss). these... | Ver |
| 02.001.056 | Oncologic application for OPDIVO® (nivolumab) | Oct 24, 2024 | Policy Archived | This policy statement applies to clinical review performed for pre-service (prior approval, precertification,... | Ver |
| 02.001.059 | Pediatric Central Nervous System Cancers – Pediatric Diffuse High-Grade Gliomas | Oct 24, 2024 | Oct 20, 2025 | Keytruda may be considered medically necessary in patients with: labeled indications: biliary tract... | Ver |
| 02.001.061 | Gazyva® (obinutuzumab) | Oct 24, 2024 | Oct 20, 2025 | Obinutuzumab intravenous obinutuzumab (gazyva) may be considered medically necessary to treat patients... | Ver |
| 02.001.063 | Intra-Articular Hyaluronan Injections for Osteoarthritis | May 06, 2024 | May 20, 2025 | Intra-articular hyaluronan injections of the knee are considered investigational. intra-articular... | Ver |
| 02.001.065 | Polysomnography for Non-Respiratory Sleep Disorders | Jul 08, 2024 | Jul 20, 2025 | Polysomnography (psg) and a multiple sleep latency test performed on the day after the psg may be... | Ver |
| 02.001.066 | Navigated Transcranial Magnetic Stimulation | Aug 27, 2024 | Policy Archived | Navigated transcranial magnetic stimulation is considered investigational for all purposes, including but... | Ver |
| 02.001.067 | Neurofeedback | Aug 06, 2024 | Policy Archived | Neurofeedback is... | Ver |
| 02.001.068 | Biofeedback as a Treatment of Urinary Incontinence in Adults | Nov 06, 2024 | Nov 20, 2025 | Biofeedback is a technique to teach patients self-regulation of physiologic processes not generally... | Ver |
| 02.001.069 | Dermatologic Applications of Photodynamic Therapy | Jan 14, 2025 | Jan 20, 2026 | Photodynamic therapy may be considered medically necessary as a treatment of: nonhyperkeratotic actinic... | Ver |
| 02.001.070 | Laser Treatment of Onychomycosis | Jan 20, 2025 | Jan 20, 2026 | Laser treatment of onychomycosis is... | Ver |
| 02.001.071 | Vestibular Function Testing | Mar 05, 2024 | Mar 20, 2025 | Vestibular function testing using an electronystagmography and videonystagmography testing batteries, caloric... | Ver |
| 02.001.072 | Biofeedback as a Treatment of Fecal Incontinence or Constipation | Dec 03, 2024 | Dec 20, 2025 | Biofeedback for constipation in adults may be considered medically necessary for patients with... | Ver |
| 02.001.073 | Neural Therapy | Dec 20, 2024 | Dec 20, 2025 | Neural therapy is considered investigational for all... | Ver |
| 02.001.074 | Confocal Laser Endomicroscopy | Dec 20, 2024 | Dec 20, 2025 | Confocal laser endomicroscopy (cle), also known as confocal fluorescent endomicroscopy and optical... | Ver |
| 02.001.075 | Peroral Endoscopic Myotomy for Treatment of Esophageal Achalasia and Gastroparesis | Dec 09, 2024 | Dec 20, 2025 | Peroral endoscopic myotomy is considered investigational as a treatment for pediatric and adult esophageal... | Ver |
| 02.001.076 | Fecal Microbiota Transplantation | Dec 09, 2024 | Dec 20, 2025 | Fecal microbiota transplantation using a compounded product (see policy guidelines) may be... | Ver |
| 02.001.077 | Epidural Steroid Injections for Neck or Back Pain | Dec 20, 2024 | Dec 20, 2025 | Epidural steroid injections performed with fluoroscopic guidance may be considered medically necessary for... | Ver |
