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
02.002.016 Cardiac Hemodynamic Monitoring For The Management Of Heart Failure In The Outpatient Setting Jul 2025 A variety of outpatient cardiac hemodynamic monitoring devices are intended to improve quality of life and... View
02.002.017 Transcoronary Ablation Of Septal Hypertrophy (TASH) Jun 2020 Hypertrophic cardiomyopathy is a complex cardiac disease associated with diverse clinical, morphologic, and... View
02.002.018 Progenitor Cell Therapy For The Treatment Of Damaged Myocardium Due To Ischemia Jul 2024 Progenitor cell therapy describes the use of multipotent cells of various cell lineages (autologous or... View
02.002.019 Catheter Ablation As Treatment For Atrial Fibrillation Apr 2026 Atrial fibrillation frequently arises from an abnormal focus at or near the junction of the pulmonary veins... View
02.002.021 Evaluación de las subclases de lipoproteína de alta densidad en el diagnóstico Nov 2017 ... View
02.002.022 Ambulatory Event Monitors And Mobile Cardiac Outpatient Telemetry Mar 2026 Various devices are available for outpatient cardiac rhythm monitoring. these devices differ in the types of... View
02.002.023 Wearable Cardioverter Defibrillators Jun 2025 A wearable cardioverter defibrillator (wcd) is a temporary, external device that is an alternative to an... View
02.002.024 Electrocardiografia de derivacion sencilla (SAECG) Nov 2017 ... View
02.002.027 Mapeo Electrofisiologico Tridimensional Intracardiaco May 2016 ... View
02.002.028 Echocardiography May 2019 ... View
02.002.029 Optical Coherence Tomography For Imaging Of Coronary Arteries Mar 2019 Optical coherence tomography (oct) is an imaging technique that uses near-infrared light to image the... View
02.002.030 Cardiografia Acustica Aug 2017 ... View
02.002.031 Transcatheter Mitral Valve Repair Jun 2025 Transcatheter mitral valve repair (tmvr) is an alternative to surgical therapy for mitral regurgitation (mr).... View
02.002.033 Ultrafiltration In Decompensated Heart Failure Jul 2021 Ultrafiltration is used to remove excess fluid from patients with volume overload and heart failure. it... View
02.002.034 Percutaneous Left Atrial Appendage Closure Devices For Stroke Prevention In Atrial Fibrillation Jun 2025 Stroke prevention in patients with atrial fibrillation (af) is an important goal of treatment. treatment with... View
02.002.035 Myocardial Strain Imaging Jun 2025 Myocardial strain refers to the deformation (shortening, lengthening, or thickening) of the myocardium... View
02.002.036 Phrenic Nerve Stimulation For Central Sleep Apnea Jun 2025 Central sleep apnea (csa) is characterized by sleep-disordered breathing due to diminished or absent... View
02.002.037 Leadless Cardiac Pacemakers Jul 2025 Pacemakers are intended to be used as a substitute for the heart’s intrinsic pacing system to correct... View
02.002.038 Intravascular Lithotripsy Sep 2025 Intravascular lithotripsy (ivl) delivers unfocused, circumferential, pulsatile mechanical energy to safely... View
02.002.039 Treatment of Congenital Athymia Dec 2025 Congenital athymia is an ultra rare condition in which infants are born without a functioning thymus. the... View