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 |
|---|---|---|---|---|
| 07.001.125 | Surgical Deactivation Of Headache Trigger Sites | Mar 2026 | Migraine is a common headache disorder that is treated using various medications, which can be taken at the... | View |
| 07.001.126 | Handheld Radiofrequency Spectroscopy For Intraoperative Assessment Of Surgical Margins During Breast-Conserving Surgery | Mar 2026 | As part of the treatment of localized breast cancer, breast-conserving surgery is optimally achieved by... | View |
| 07.001.127 | Surgery For Groin Pain In Athletes | Mar 2026 | Sports-related groin pain, commonly known as athletic pubalgia or sports hernia, is characterized by... | View |
| 07.001.128 | Balloon Dilation Of The Eustachian Tube | Mar 2026 | Eustachian tube dysfunction (etd) occurs when the functional valve of the eustachian tube fails to open... | View |
| 07.001.129 | Synthetic Cartilage Implants For Joint Pain | Aug 2025 | Articular cartilage damage, either from a focal lesion or diffuse osteoarthritis (oa), can result in... | View |
| 07.001.132 | Rhinoplasty | Nov 2021 | Rhinoplasty rhinoplasty is a procedure to correct congenital anatomical deformities acquired in the nostrils.... | View |
| 07.001.133 | Radiofrequency Coblation Tenotomy For Musculoskeletal Conditions | Jan 2026 | Radiofrequency (rf) coblation is being evaluated for the treatment of plantar fasciitis, lateral... | View |
| 07.001.134 | Steroid-Eluting Sinus Stents | Mar 2026 | Steroid-eluting sinus stents are devices used postoperatively following endoscopic sinus surgery (ess) or for... | View |
| 07.001.139 | Peripheral Subcutaneous Field Stimulation | May 2026 | ... | View |
| 07.001.143 | Responsive Neurostimulation For The Treatment Of Refractory Focal Epilepsy | May 2026 | Approximately one-third of individuals with epilepsy do not respond to typical first-line therapy with... | View |
| 07.001.146 | Discectomy | Feb 2026 | ... | View |
| 07.001.148 | Endovascular Therapies For Extracranial Vertebral Artery Disease | Jul 2024 | Vertebral artery diseases, including atherosclerotic stenosis, dissections, and aneurysms, can lead to... | View |
| 07.001.151 | Prostatic Urethral Lift | Sep 2025 | Benign prostatic hyperplasia (bph) is a common condition in older individuals that can lead to increased... | View |
| 07.001.152 | Magnetic Resonance Imaging-Targeted Biopsy Of The Prostate | Oct 2024 | Before a transrectal ultrasound-guided biopsy, a magnetic resonance imaging (mri) scan can be used to... | View |
| 07.001.155 | Functional Endoscopic Sinus Surgery For Chronic Rhinosinusitis | Mar 2026 | Chronic rhinosinusitis (crs) is a common chronic condition associated with significant morbidity. functional... | View |
| 07.001.156 | Autologous Chondrocyte Implantation For Focal Articular Cartilage Lesions | May 2026 | A variety of procedures are being developed to resurface articular cartilage defects. autologous chondrocyte... | View |
| 07.001.157 | Open And Thoracoscopic Approaches To Treat Atrial Fibrillation And Atrial Flutter (Maze And Related Procedures) | Apr 2026 | There are various surgical approaches to treat atrial fibrillation (af) that work by interrupting abnormal... | View |
| 07.001.159 | Radiofrequency Ablation Of The Renal Sympathetic Nerves As A Treatment For Resistant Hypertension | Aug 2025 | Radiofrequency ablation (rfa) of the renal sympathetic nerves is thought to decrease both the afferent... | View |
| 07.001.161 | Patient Specific Instrumentation (Eg Cutting Guides) For Joint Arthroplasty | May 2026 | Patient-specific instrumentation has been developed as an alternative to conventional cutting guides for... | View |
| 07.001.162 | Allograft Injection For Degenerative Disc Disease | Jun 2025 | Degeneration of the intervertebral discs is commonly observed in imaging and has been proposed to be a source... | View |