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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 |
|---|---|---|---|---|---|
| 02.001.049 | Hypnosis | Apr 05, 2019 | Policy Archived | Hypnosis is considered medically necessary when used to control acute or chronic pain, or as an adjunct to... | Ver |
| 02.001.051 | Orthopedic Applications of Platelet-Rich Plasma | May 17, 2024 | May 20, 2025 | Use of platelet-rich plasma is considered investigational for all orthopedic indications. this includes,... | Ver |
| 02.001.052 | Noncontact Ultrasound Treatment for Wounds | Feb 12, 2024 | Feb 20, 2025 | Noncontact ultrasound treatment for wounds is... | Ver |
| 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 07, 2023 | Jul 20, 2024 | 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 | Automated point-of-care nerve conduction tests are considered investigational.... | Ver |
| 02.001.056 | Oncologic application for OPDIVO® (nivolumab) | Dec 14, 2023 | Oct 20, 2024 | This policy statement applies to clinical review performed for pre-service (prior approval, precertification,... | Ver |
| 02.001.059 | KEYTRUDA® (pembrolizumab) | Dec 14, 2023 | Oct 20, 2024 | Keytruda may be considered medically necessary in patients with: labeled indications: melanoma:... | Ver |
| 02.001.061 | Gazyva® (obinutuzumab) | Oct 26, 2023 | Oct 20, 2024 | 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 |
| 02.001.064 | Phototherapy for Vitiligo | Apr 18, 2024 | Retired Policy | Puva for the treatment of vitiligo, which does not respond to other forms of therapy conservative (e.g.,... | 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 | Jul 16, 2024 | Jul 20, 2025 | Navigated transcranial magnetic stimulation is considered investigational for all purposes, including but... | Ver |
| 02.001.067 | Neurofeedback | Jul 15, 2024 | Jul 20, 2025 | Neurofeedback is... | Ver |
| 02.001.068 | Biofeedback as a Treatment of Urinary Incontinence in Adults | Sep 05, 2023 | Sep 20, 2024 | Biofeedback in the outpatient setting is considered investigational as a treatment of urinary incontinence in... | Ver |
| 02.001.069 | Dermatologic Applications of Photodynamic Therapy | Jan 08, 2024 | Jan 20, 2025 | Photodynamic therapy may be considered medically necessary as a treatment of: nonhyperkeratotic actinic... | Ver |
| 02.001.070 | Laser Treatment of Onychomycosis | Jan 22, 2024 | Jan 20, 2025 | 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 04, 2023 | Dec 20, 2024 | Biofeedback for constipation in adults may be considered medically necessary for patients with... | Ver |
| 02.001.073 | Neural Therapy | Dec 20, 2023 | Dec 20, 2024 | Neural therapy is considered investigational for all... | Ver |
