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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 |
|---|---|---|---|---|---|
| 02.001.074 | Confocal Laser Endomicroscopy | Dec 20, 2023 | Dec 20, 2024 | Use of confocal laser endomicroscopy is considered... | Ver |
| 02.001.075 | Peroral Endoscopic Myotomy for Treatment of Esophageal Achalasia and Gastroparesis | Dec 11, 2023 | Dec 20, 2024 | Peroral endoscopic myotomy is considered investigational as a treatment for pediatric and adult esophageal... | Ver |
| 02.001.076 | Fecal Microbiota Transplantation | Dec 11, 2023 | Dec 20, 2024 | 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, 2023 | Dec 20, 2024 | The diagnosis of lumbar radiculopathy is typically made by a combination of suggestive signs and symptoms in... | Ver |
| 02.001.086 | Targeted Phototherapy and Psoralen with Ultraviolet A for Vitiligo | Jan 08, 2024 | Jan 20, 2025 | Psoralen plus ultraviolet a for the treatment of vitiligo that is not responsive to other forms of... | Ver |
| 02.001.103 | Trigger Point and Tender Point Injections | May 21, 2024 | May 20, 2025 | Trigger point injections with anesthetic and/or corticosteroid may be considered medically necessary for the... | Ver |
| 02.001.104 | Desensitization Treatment for Peanut Allergies | Jul 10, 2024 | Jul 20, 2025 | The use of peanut (arachis hypogaea) allergen powder-dnfp is considered investigational for all... | Ver |
| 02.001.105 | Digital Health Technologies: Diagnostic Applications | Sep 05, 2023 | Sep 20, 2024 | Prescription digital health technologies for diagnostic application that have received clearance for... | Ver |
| 02.002.001 | Percutaneous Transluminal Coronary Angioplasty | Aug 31, 2023 | Policy Archived | Percutaneous coronary transluminal angioplasty is considered for payment in the treatment of acute myocardial... | Ver |
| 02.002.002 | Gamma Radiation in the Prevention of Dilation Catheter restenosis Coronary | Jul 01, 2024 | Retired | Intravascular coronary brachytherapy using beta or gamma radiation is considered for payment as treatment of... | Ver |
| 02.002.003 | Total Artificial Hearts and Implantable Ventricular Assist Devices | Sep 12, 2023 | Sep 20, 2024 | Implantable ventricular assist devices (vads) with u.s. food and drug administration (fda) approval or... | Ver |
| 02.002.004 | Electrocardiography (EKG, ECG) | Aug 22, 2023 | Policy Archived | 1. ekg services are covered diagnostic tests when there are documented signs and symptoms or other clinical... | Ver |
| 02.002.005 | ECOCARDIOGRAFIA POR DOPPLER | May 06, 2016 | Policy Archived | Esta tecnología no invasiva se considera para pago, en adultos y niños para medir gasto cardiaco, velocidad... | Ver |
| 02.002.006 | PRUEBA DE ESFUERZO CON PERFUSION DEL MIOCARDIO (Stress Test) | Aug 22, 2023 | Policy Archived | Si el cardiólogo sólo supervisa una prueba de esfuerzo cardiovascular, debe usar el código 93016.... | Ver |
| 02.002.007 | Routine EKG Prior To IV Sedation & Other Indications | Jun 22, 2023 | Policy Archived | Triple-s considers for payment an ekg (code 93000) prior to a ambulatory procedure and under intravenous... | Ver |
| 02.002.008 | Ultrasonographic Measurement of Carotid Intima-Medial Thickness as an Assessment of Subclinical Atherosclerosis | Jun 18, 2024 | Jun 20, 2025 | Ultrasonographic measurement of carotid intima-media thickness as a technique for identifying subclinical... | Ver |
| 02.002.009 | Biventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure | Jun 10, 2024 | Jun 20, 2025 | Biventricular pacemakers with or without an accompanying implantable cardiac defibrillator (ie, a combined... | Ver |
| 02.002.011 | Catheter Ablation for Cardiac Arrhythmias | Aug 21, 2023 | Policy Archived | Catheter ablation may be considered medically necessary for the treatment of supraventricular... | Ver |
| 02.002.012 | Enhanced External Counterpulsation | Jun 11, 2024 | Jun 20, 2025 | Enhanced external counterpulsation is considered investigational for all indications, including but not... | Ver |
| 02.002.013 | Automated Ambulatory Blood Pressure Monitoring for Diagnosis of Hypertension in Patients With Elevated Office Blood Pressure | Aug 11, 2023 | Aug 20, 2024 | Automated ambulatory blood pressure (bp) monitoring over a 24-hour period may be considered medically... | Ver |
