Medical Policies
Medical policies are documents that define the plan coverage for technologies, procedures and treatments. The statements of medical necessity in the policies, about whether a technology, procedure, treatment, supply, equipment, drug or other service improves the health outcome of the population for which said technology or treatment was designed are based on scientific evidence, clinical studies and professional opinions from our providers and recognized medical organizations.
Each document displayed on this website is provided for informational purposes only and is not an authorization, explanation of benefits, or contract. Receiving benefits is subject to satisfaction of all terms and conditions of coverage. Medical technology is constantly changing, and we reserve the right to periodically review and update our policies.
Medical Policies table
| ID | Title | Review | Description | Access |
|---|---|---|---|---|
| 07.001.028 | Injectable Bulking Agents For The Treatment Of Urinary And Fecal Incontinence | Apr 2026 | Bulking agents are injectable substances used to increase tissue bulk. they can be injected periurethrally to... | View |
| 07.001.029 | Spinal Cord And Dorsal Root Ganglion Stimulation | May 2026 | Spinal cord stimulation delivers low-voltage electrical stimulation to the dorsal columns of the spinal cord... | View |
| 07.001.030 | Vagus Nerve Stimulation | Mar 2026 | Stimulation of the vagus nerve can be performed using a pulsed electrical stimulator implanted within the... | View |
| 07.001.031 | Deep Brain Stimulation | May 2026 | Deep brain stimulation involves the stereotactic placement of an electrode into a central nervous system... | View |
| 07.001.033 | Otoplasty | Nov 2022 | Reconstructive surgery of the ear can be considered for injury, trauma or congenital conditions. congenital... | View |
| 07.001.034 | Litotripcia, onda de choque extracorporea (ESWL) | Jun 2023 | Shock wave lithotripsy — extracorporeal shock wave lithotripsy (eswl)remains one of the most commonly... | View |
| 07.001.037 | Bone Morphogenetic Protein | May 2026 | Two recombinant human bone morphogenetic proteins (rhbmps) have been extensively studied: recombinant human... | View |
| 07.001.039 | Meniscal Allografts And Other Meniscal Implants | May 2026 | Meniscal allografts and other meniscal implants (eg, collagen) are intended to improve symptoms and reduce... | View |
| 07.001.040 | Cirugia reconstructiva post cirugia baríatrica | Jun 2023 | Morbid obesity is defined as an increase in body weight above an optimal level resulting in significant... | View |
| 07.001.041 | Cochlear Implant | Mar 2026 | A cochlear implant is a device for treatment of severe-to-profound hearing loss in individuals who only... | View |
| 07.001.042 | Percutaneous Intradiscal Electrothermal Annuloplasty, Radiofrequency Annuloplasty, And Biacuplasty | May 2026 | Electrothermal intradiscal annuloplasty therapies use radiofrequency energy sources to treat discogenic low... | View |
| 07.001.043 | Autografts And Allografts In The Treatment Of Focal Articular Cartilage Lesions | May 2026 | Osteochondral grafts are used to repair full-thickness chondral defects involving a joint. in the case of... | View |
| 07.001.044 | Implantable Bone-Conduction And Bone-Anchored Hearing Aids | Mar 2025 | Sensorineural, conductive, and mixed hearing loss may be treated with various devices, including conventional... | View |
| 07.001.045 | Surgical Ventricular Restoration | Mar 2026 | Surgical ventricular restoration is designed to restore or remodel the left ventricle to its normal,... | View |
| 07.001.047 | Cirugía robótica | May 2016 | ... | View |
| 07.001.048 | Intraoperative Neurophysiologic Monitoring | May 2026 | Intraoperative neurophysiologic monitoring describes a variety of procedures used to monitor the integrity of... | View |
| 07.001.049 | Percutaneous Nephrostolithotomy And Lithetripsy For Kidney Stones | Sep 2019 | Percutaneous nephrostolithotomy (pcn) is an invasive procedure for removing upper urinary tract stones by... | View |
| 07.001.050 | Implantable Cardioverter Defibrillators | Jun 2025 | An implantable cardioverter defibrillator (icd) is a device designed to monitor a patient's heart rate,... | View |
| 07.001.051 | Balloon Ostial Dilation For Treatment Of Chronic Rhinosinusitis | Mar 2026 | Balloon ostial dilation (bod, also known as balloon sinuplasty) is proposed as an alternative to functional... | View |
| 07.001.052 | Tibial Nerve Stimulation | Feb 2026 | Percutaneous tibial nerve stimulation (ptns; also known as posterior tibial nerve stimulation) is an... | View |