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
02.005.001 Pulmonary Function Test Oct 2025 Chronic obstructive pulmonary disease, or copd, is a condition caused by damage to the airways or other parts... View
02.005.002 ASISTENCIA Y MANEJO DEL VENTILADOR MECANICO (VENTILATION ASSIST AND MANAGEMENT) Aug 2017 ... View
02.005.003 Oximetry Jan 2020 Pulse oximetry is a non-invasive way to measure oxygen levels in the blood. it may be used in a home, office... View
02.005.004 Oximetría continua May 2016 ... View
02.005.005 Terapia con inhibidores de Alfa 1 Proteinasa May 2016 ... View
02.005.006 Diagnosis of Obstructive Sleep Apnea Syndrome Aug 2025 Obstructive sleep apnea (osa) syndrome is characterized by repetitive episodes of upper airway obstruction... View
02.005.007 Espirometría Casera Aug 2017 ... View
02.005.008 Síndrome de Obstrucción en el Conducto Aéreo Superior Nov 2017 ... View
02.005.009 Non-Invasive Positive Airway Pressure for Chronic Obstructive Pulmonary Disease Apr 2026 Respiratory failure is characterized by low arterial blood oxygen (hypoxemia, pao2) and/or high arterial... View
02.005.010 Medical Management of Obstructive Sleep Apnea Syndrome Jul 2025 Obstructive sleep apnea (osa) syndrome is characterized by repetitive episodes of upper airway obstruction... View
02.007.001 ESTIMULACION REPETITIVA DEL NERVIO (RNS) Jun 2023 Repetitive nerve stimulation (rns) and single-fiber electromyography (sfemg) are important confirmatory tests... View
02.007.003 ELECTROENCEFALOGRAFIA CON EKG May 2016 ... View
02.007.004 Somatosensory Evoked Potential Studies Visual/Auditory Nov 2021 Evoked potentials are somatosensory stimuli, visual and/or auditory. the same, when applied activate... View
02.007.006 Topografía cerebral (“Topographic Brain Mapping”) Nov 2017 ... View
02.007.007 Electroencefalografía digital Jul 2025 It is the technological method of acquiring and recording the electroencephalogram without the use of paper.... View
02.007.008 Electroencephalograms (Eeg) Jul 2023 An electroencephalogram (eeg) is a recording of electrical current potentials spontaneously from nerve cells... View
02.007.009 Autonomic Nervous System Testing Jul 2025 The autonomic nervous system (ans) controls physiologic processes that are not under conscious control.... View
02.007.011 Neuropsychological Test Nov 2024 Neuropsychology is defined as the study (knowledge, evaluation and modification) of the brain-behavior... View
02.007.012 Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions Aug 2025 Peripheral nerve stimulation (pns) is a percutaneous system consisting of leads, electrodes, and a pulse... View
02.007.013 Tonic Motor Activation (TOMAC) for Restless Leg Syndrome Nov 2025 Tonic motor activation (tomac) is a peroneal nerve stimulation device that uses electrodes worn on the lower... View