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 |
|---|---|---|---|---|
| 02.001.007 | Antibióticos en aerosol como tratamiento de la sinusitis crónica | Jun 2016 | ... | View |
| 02.001.008 | Monitoreo del flujo sanguíneo cerebral regional usando una sonda térmica | May 2016 | ... | View |
| 02.001.009 | Suspensión de la vegija urinaria usando radiofrecuencia transvaginal para incont | Aug 2017 | ... | View |
| 02.001.010 | Nonpharmacologic Treatment Of Rosacea | Jan 2026 | Rosacea is a chronic, inflammatory skin condition without a known cure; the goal of treatment is symptom... | View |
| 02.001.011 | Hyperbaric Oxygen Therapy | Mar 2026 | Hyperbaric oxygen therapy (hbot) involves breathing 100% oxygen at pressures between 1.5 and 3.0 atmospheres.... | View |
| 02.001.012 | Continuous Or Intermittent Monitoring Of Glucose In Interstitial Fluid | Feb 2026 | ... | View |
| 02.001.013 | Stent prostático temporero | May 2016 | ... | View |
| 02.001.014 | Vendaje de calor radiante para el tratamiento de heridas | Jun 2016 | ... | View |
| 02.001.015 | Paraspinal Surface Electromyography To Evaluate And Monitor Back Pain | Jul 2025 | A noninvasive procedure that records the summation of muscle electrical activity, paraspinal surface... | View |
| 02.001.016 | Terapia con potenciacion con insulina | May 2016 | ... | View |
| 02.001.017 | Laser Treatment Of Active Acne | Mar 2020 | Acne is a condition of the pilosebaceous follicular glands that affects mainly adolescents and young adults... | View |
| 02.001.018 | Electrostimulation And Electromagnetic Therapy For Treating Wounds | Feb 2026 | Electrostimulation (electrical stimulation) refers to the application of electrical current through... | View |
| 02.001.019 | Estimulación sensorial en pacientes comatosos | May 2016 | ... | View |
| 02.001.020 | Endovascular Procedures For Intracranial Arterial Disease (Atherosclerosis And Aneurysms) | May 2026 | Intracranial arterial disease includes thromboembolic events, vascular stenoses, and aneurysms. endovascular... | View |
| 02.001.022 | Quantitative Sensory Testing | Jul 2025 | Quantitative sensory testing (qst) systems are used for the noninvasive assessment and quantification of... | View |
| 02.001.024 | Onda de choque extracorporea en el tratamiento de la enfermedad de peyronie | May 2016 | ... | View |
| 02.001.025 | High Intensity Laser Therapy | Nov 2022 | Conventional laser therapy has been used in europe for more than 25 years. up to this moment, this therapy... | View |
| 02.001.026 | Electromyography And Nerve Conduction Studies | Sep 2025 | Electromyography and nerve conduction studies, also collectively known as an electrodiagnostic assessment,... | View |
| 02.001.027 | Percutaneous Treatment Of Fracture Non-Unions Or Bone Defects With Autologous Bone Marrow With Demineralized Bone Matrix (Dbm) | Apr 2019 | The standard treatment of problem fractures or osseous defects has been an autologous cancellous bone graft... | View |
| 02.001.028 | Psoralens con luz ultravioleta A (PUVA) | May 2016 | ... | View |