Políticas médicas
La autorización previa para atención hospitalaria aguda, hospital de atención aguda a largo plazo (LTACH), procedimientos seleccionados y servicios de salud conductual seleccionados se llevará a cabo utilizando los criterios InterQual® de Change Healthcare. Los criterios de InterQual son un conjunto estándar de la industria de criterios objetivos de gestión de utilización (UM) basados en evidencia para el nivel de ubicación de atención y determinaciones de necesidad médica, incluida la duración de la hospitalización. Estos criterios son pautas clínicas específicas y completas desarrolladas por un equipo clínico altamente capacitado que realiza una revisión sistemática y una evaluación clínica imparcial de la evidencia para ayudar a garantizar que los criterios reflejen la mejor evidencia clínica disponible. Los criterios se actualizan con frecuencia para mantenerse actualizados con la evidencia más reciente.
La autorización previa para servicios seleccionados para trastornos por abuso de sustancias se realizará utilizando los criterios de la American Society of Addiction Medicine (ASAM).
Los criterios de la ASAM son una recopilación estándar de la industria de pautas para el nivel de atención y las determinaciones de necesidad médica, incluida la duración de la hospitalización para los servicios para trastornos por uso de sustancias.
Encuentre las políticas médicas que necesita en la siguiente biblioteca. Si no encuentra las políticas médicas, visite la lista de servicios especializados para confirmar si necesita una revisión de necesidad médica.
Para servicios especializados administrados por compañías independientes en nombre de Capital Blue Cross:
- Radiología de alta tecnología que incluye diagnóstico por imagen cardiovascular y oncología radioterápica
- Servicios de laboratorio
- Servicios de administración de pruebas de laboratorio moleculares: a partir del 1 de enero de 2026, la administración de EviCore de las autorizaciones previas para pruebas moleculares y genómicas de pacientes ambulatorios se ampliará para incluir a los miembros de Capital Blue Cross con servicios administrativos únicamente (ASO). (se excluyen algunos grupos ASO). A partir del 1 de noviembre de 2025, EviCore comenzó a administrar estos servicios para miembros comerciales con seguro completo, CHIP y Medicare Advantage.
- Pólizas para trastornos musculoesqueléticos, incluidos los servicios relacionados con la cadera, rodilla, hombros y columna vertebral
- Ciertos servicios de cardiología quirúrgica y de diagnóstico
You can also view the out-of-area medical policies.
Inyectables especializados:
A partir del 1 de enero de 2026, Prime Medical Pharmacy Solutions1 (Prime MPS) administrará los servicios relacionados con medicamentos médicos inyectables especializados, en nombre de Capital.
Los medicamentos inyectables especializados pueden requerir autorización previa a través de Prime MPS. Consulte la lista de códigos de autorización previa de una sola fuente. Además, es posible que algunos medicamentos tengan un requisito de sitio de servicio.
Para conocer más acerca de los criterios de cobertura, incluidos los requisitos del sitio de servicio de infusión de medicamentos, puede acceder a las políticas de medicamentos de Prime.
1En nombre de Capital Blue Cross, Prime Medical Pharmacy Solutions (Prime MPS), una división de Prime Therapeutics Management, LLC, una compañía independiente, brinda servicios de administración de medicamentos especializados.
Información de Medicare:
Para obtener más información sobre la póliza y cobertura de Medicare, consulte la página Póliza de seguro médico de Medicare.
Search active and retired medical policies
Número de la política |
Categoría |
Título de la política |
Policy type |
|---|---|---|---|
|
MP 1.012 |
Cirugía |
Abdominoplasty and Panniculectomy (Abdominoplastia y paniculectomía) |
Active |
|
MP 2.376 |
Medicine |
Ablation of Peripheral Nerves to Treat Pain (Ablación de nervios periféricos para tratar el dolor) |
Active |
|
MP 2.087 |
Medicine |
Active |
|
|
MP 2.390 |
Medicine |
Active |
|
|
MP 6.056 |
Equipos médicos duraderos |
Active |
|
|
MP 3.017 |
Ancillary Services |
Air and Water Ambulance Services (Servicios de ambulancia aérea y acuática) |
Active |
|
MP 6.015 |
Ancillary Services |
Airway Clearance Devices (Dispositivos de limpieza de las vías respiratorias) |
Active |
|
MP 2.001 |
Medicine |
Allergy Testing and Immunotherapy (Pruebas de alergia e inmunoterapia) |
Active |
|
MP 9.056 |
Trasplante |
Active |
|
|
MP 9.055 |
Trasplante |
Allogeneic Hematopoietic Cell Transplantation for Genetic Diseases and Acquired Anemias |
Active |
|
MP 1.159 |
Cirugía |
Active |
|
|
MP 2.359 |
Medicine |
Active |
|
|
MP 6.062 |
Equipos médicos duraderos |
Ankle-Foot and Knee-Ankle-Foot Orthoses (Órtesis de tobillo y pie, y de rodilla, tobillo y pie) |
Active |
|
MP 2.149 |
Medicine |
Active |
|
|
MP 2.304 |
Medicine |
Active |
|
|
MP 2.317 |
Medicine |
Active |
|
|
MP 1.157 |
Cirugía |
Active |
|
|
MP 1.119 |
Cirugía |
Active |
|
|
MP 1.015 |
Cirugía |
Active |
|
|
MP 1.142 |
Cirugía |
Baroreflex Stimulation Device (Dispositivo de estimulación barorrefleja) |
Active |
|
MP 1.158 |
Cirugía |
Active |
|
|
MP 2.064 |
Medicine |
Biofeedback and Neurofeedback Therapy (Terapia de biorretroalimentación y neurorretroalimentación) |
Active |
|
MP 2.190 |
Medicine |
Active |
|
|
MP 1.003 |
Cirugía |
Active |
|
|
MP 2.081 |
Medicine |
Active |
|
|
MP 2.158 |
Medicine |
Active |
|
|
MP 2.051 |
Medicine |
Active |
|
|
MP 2.258 |
Medicine |
Carrier Screening for Genetic Diseases (Exámenes de proveedores para enfermedades genéticas) |
Active |
|
MP 7.028 |
OBGYN/Reproduction |
Active |
|
|
MP 2.267 |
Medicine |
Active |
|
|
MP 1.039 |
Cirugía |
Closure Devices for Patent Foramen Ovale and Atrial Septal Defects (ASD) |
Active |
|
MP 1.023 |
Cirugía |
Active |
|
|
MP 6.013 |
Equipos médicos duraderos |
Active |
|
|
MP 1.106 |
Cirugía |
Active |
|
|
MP 5.062 |
Radiology/Imaging |
Active |
|
|
MP 2.093 |
Medicine |
Active |
|
|
MP 6.004 |
Equipos médicos duraderos |
Active |
|
|
MP 6.039 |
Equipos médicos duraderos |
Active |
|
|
MP 6.040 |
Equipos médicos duraderos |
Active |
|
|
MP 2.028 |
Medicine |
Active |
|
|
MP 9.011 |
Trasplante |
Corneal Surgery (Formerly Corneal Transplant, Endothelial Keratoplasty, and Keratoprostheses) |
Active |
|
MP 1.004 |
Cirugía |
Cosmetic and Reconstructive Surgery (Cirugía estética y reconstructiva) |
Active |
|
MP 2.092 |
Medicine |
Cranial Electrotherapy Stimulation and Auricular Electrostimulation |
Active |
|
MP 1.088 |
Cirugía |
Cryoablation of Tumors Located in the Kidney, Lung, Breast, Pancreas, or Bone |
Active |
|
MP 1.121 |
Cirugía |
Active |
|
|
MP 2.234 |
Medicine |
Active |
|
|
MP 1.042 |
Cirugía |
Active |
|
|
MP 2.381 |
Medicine |
Active |
|
|
MP 1.092 |
Cirugía |
Active |
|
|
MP 4.018 |
Other Treatments |
Active |
|
|
MP 4.033 |
Other Treatments |
Diagnosis and Treatment of Dry Eye Syndrome (Diagnóstico y tratamiento del síndrome del ojo seco) |
Active |
|
MP 5.048 |
Radiology/Imaging |
Active |
|
|
MP 2.045 |
Medicine |
Active |
|
|
MP 2.050 |
Medicine |
Active |
|
|
MP 2.004 |
Medicine |
Active |
|
|
MP 4.041 |
Other Treatments |
Active |
|
|
MP 6.026 |
Equipos médicos duraderos |
Active |
|
|
MP 2.011 |
Medicine |
Active |
|
|
MP 5.051 |
Radiology/Imaging |
Active |
|
|
MP 1.024 |
Cirugía |
Active |
|
|
MP 1.150 |
Cirugía |
Active |
|
|
MP 2.096 |
Medicine |
Active |
|
|
MP 2.063 |
Medicine |
Active |
|
|
MP 7.013 |
OBGYN/Reproduction |
Active |
|
|
MP 1.118 |
Cirugía |
Endoscopic Radiofrequency Ablation or Cryoablation for Barrett's Esophagus |
Active |
|
MP 1.090 |
Cirugía |
Active |
|
|
MP 1.132 |
Cirugía |
Active |
|
|
MP 2.015 |
Medicine |
Active |
|
|
MP 4.014 |
Other Treatments |
Active |
|
|
MP 2.016 |
Medicine |
Active |
|
|
MP 2.367 |
Medicine |
Active |
|
|
MP 2.017 |
Medicine |
Active |
|
|
MP 2.391 |
Medicine |
Active |
|
|
MP 4.029 |
Other Treatments |
Active |
|
|
MP 2.386 |
Medicine |
Active |
|
|
MP 4.002 |
Other Treatments |
Experimental and Investigational Procedures (Procedimientos experimentales y de investigación) |
Active |
|
MP 6.007 |
Medicine |
Active |
|
|
MP 2.068 |
Medicine |
Active |
|
|
MP 2.034 |
Medicine |
Active |
|
|
MP 5.049 |
Radiology/Imaging |
Facet Joint Denervation (Denervación de la articulación de la carilla vertebral) |
Active |
|
MP 2.018 |
Medicine |
Active |
|
|
MP 6.028 |
Equipos médicos duraderos |
Foot Orthotics and Other Podiatric Appliances (Ortopedia para pies y otros artículos de podiatría) |
Active |
|
MP 2.378 |
Medicine |
Active |
|
|
MP 6.031 |
Equipos médicos duraderos |
Active |
|
|
MP 2.069 |
Medicine |
Gastric Electrical Stimulation (Estimulación eléctrica gástrica) |
Active |
|
MP 1.144 |
Cirugía |
Active |
|
|
MP 2.245 |
Medicine |
Active |
|
|
MP 2.315 |
Medicine |
Active |
|
|
MP 2.280 |
Medicine |
Active |
|
|
MP 2.396 |
Medicine |
Active |
|
|
MP 2.360 |
Medicine |
Active |
|
|
MP 2.313 |
Medicine |
Gene Expression Testing in Patients with Stable Ischemic Heart Disease |
Active |
|
MP 2.323 |
Medicine |
Active |
|
|
MP 2.326 |
Medicine |
General Approach to Genetic Testing (Enfoque general sobre la prueba genética) |
Active |
|
MP 2.325 |
Medicine |
Active |
|
|
MP 2.320 |
Medicine |
Genetic Testing for Alpha Thalassemia (Prueba genética de talasemia alfa) |
Active |
|
MP 2.251 |
Medicine |
Active |
|
|
MP 2.050 |
Medicine |
Active |
|
|
MP 2.322 |
Medicine |
Genetic Testing for CHARGE Syndrome (Prueba genética del síndrome de CHARGE) |
Active |
|
MP 2.233 |
Medicine |
Active |
|
|
MP 2.242 |
Medicine |
Active |
|
|
MP 2.242 |
Medicine |
Active |
|
|
MP 2.264 |
Medicine |
Active |
|
|
MP 2.257 |
Medicine |
Active |
|
|
MP 2.262 |
Medicine |
Genetic Testing for Epilepsy (Prueba genética de la epilepsia) |
Active |
|
MP 2.357 |
Medicine |
Active |
|
|
MP 2.321 |
Medicine |
Active |
|
|
MP 2.246 |
Medicine |
Active |
|
|
MP 2.362 |
Medicine |
Genetic Testing for Fanconi Anemia (Pruebas genéticas para la anemia de Fanconi) |
Active |
|
MP 2.308 |
Medicine |
Active |
|
|
MP 2.319 |
Medicine |
Genetic Testing for Hereditary Hearing Loss (Prueba genética de la pérdida auditiva hereditaria) |
Active |
|
MP 2.312 |
Medicine |
Genetic Testing for Hereditary Hemochromatosis (Prueba genética de la hemocromatosis hereditaria) |
Active |
|
MP 2.318 |
Medicine |
Genetic Testing for Hereditary Pancreatitis (Prueba genética de la pancreatitis hereditaria) |
Active |
|
MP 2.363 |
Medicine |
Active |
|
|
MP 2.328 |
Medicine |
Active |
|
|
MP 2.253 |
Medicine |
Genetic Testing for Inherited Thrombophilia (Pruebas genéticas de la trombofilia hereditaria) |
Active |
|
MP 2.274 |
Medicine |
Genetic Testing for Li-Fraumeni Syndrome (Pruebas genéticas del síndrome de Li-Fraumeni) |
Active |
|
MP 2.274 |
Medicine |
Active |
|
|
MP 2.310 |
Medicine |
Active |
|
|
MP 5.013 |
Radiology/Imaging |
Active |
|
|
MP 2.260 |
Medicine |
Genetic Testing for Macular Degeneration (Pruebas genéticas para detectar la degeneración macular) |
Active |
|
MP 2.331 |
Medicine |
Active |
|
|
MP 2.273 |
Medicine |
Genetic Testing For Mitochondrial disorders (Pruebas genéticas de trastornos mitocondriales) |
Active |
|
MP 2.358 |
Medicine |
Genetic Testing for Neurofibromatosis (Pruebas genéticas para la neurofibromatosis) |
Active |
|
MP 2.255 |
Medicine |
Active |
|
|
MP 2.276 |
Medicine |
Active |
|
|
MP 2.248 |
Medicine |
Active |
|
|
MP 2.355 |
Medicine |
Active |
|
|
MP 2.247 |
Medicine |
Genetic Testing of CADASIL Syndrome (Prueba genética del síndrome de CADASIL) |
Active |
|
MP 2.307 |
Medicine |
Genotype-Guided Tamoxifen Treatment (Tratamiento con tamoxifen guiado por genotipo) |
Active |
|
MP 2.306 |
Medicine |
Genotype-Guided Warfarin Dosing (Dosificación de warfarina guiada por genotipo) |
Active |
|
MP 2.311 |
Medicine |
Active |
|
|
MP 2.393 |
Medicine |
Active |
|
|
MP 2.395 |
Medicine |
Active |
|
|
MP 2.394 |
Medicine |
Active |
|
|
MP 2.279 |
Medicine |
Germline Genetic Testing for Gene Variants Associated with Breast Cancer in Individuals at High |
Active |
|
MP 2.211 |
Medicine |
Active |
|
|
MP 2.384 |
Medicine |
Active |
|
|
MP 2.392 |
Medicine |
Germline Genetic Testing for Pancreatic Cancer Susceptibility Genes |
Active |
|
MP 6.049 |
Equipos médicos duraderos |
H-Wave Electrical Stimulation (Estimulación eléctrica de onda H) |
Active |
|
MP 5.055 |
Radiology/Imaging |
Active |
|
|
MP 9.007 |
Trasplante |
Active |
|
|
MP 9.014 |
Trasplante |
Active |
|
|
MP 9.041 |
Trasplante |
Active |
|
|
MP 9.040 |
Trasplante |
Hematopoietic Cell Transplantation for Acute Myeloid Leukemia |
Active |
|
MP 9.053 |
Trasplante |
Active |
|
|
MP 9.050 |
Trasplante |
Hematopoietic Cell Transplantation for CNS Embryonal Tumors, CNS Germ Cell Tumors and Ependymoma |
Active |
|
MP 9.038 |
Trasplante |
Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma |
Active |
|
MP 9.039 |
Trasplante |
Active |
|
|
MP 9.047 |
Trasplante |
Active |
|
|
MP 9.043 |
Trasplante |
Active |
|
|
MP 9.048 |
Trasplante |
Active |
|
|
MP 9.042 |
Trasplante |
Hematopoietic Cell Transplantation for Non-Hodgkin Lymphomas |
Active |
|
MP 9.044 |
Trasplante |
Active |
|
|
MP 9.045 |
Trasplante |
Active |
|
|
MP 9.054 |
Trasplante |
Hematopoietic Cell Transplantation for Solid Tumors of Childhood |
Active |
|
MP 9.046 |
Trasplante |
Active |
|
|
MP 9.052 |
Trasplante |
Hematopoietic Cell Transplantation in the Treatment of Germ-Cell Tumors |
Active |
|
MP 6.001 |
Equipos médicos duraderos |
Active |
|
|
MP 2.070 |
Medicine |
Hyperbaric Oxygen Therapy (HBO) (Formerly Hyperbaric Oxygen Pressurization) |
Active |
|
MP 2.021 |
Medicine |
Active |
|
|
MP 1.019 |
Cirugía |
Active |
|
|
MP 1.058 |
Cirugía |
Active |
|
|
MP 1.044 |
Cirugía |
Active |
|
|
MP 4.012 |
Other Treatments |
Active |
|
|
MP 3.019 |
Ancillary Services |
Active |
|
|
MP 2.079 |
Medicine |
Intensive Pediatric Feeding Programs (Programas intensivo pediátrico de alimentación) |
Active |
|
MP 6.047 |
Equipos médicos duraderos |
Interferential Current Stimulation (Estimulación con corriente interferencial) |
Active |
|
MP 1.120 |
Cirugía |
Interventions for Progressive Scoliosis (Intervenciones para la escoliosis progresiva) |
Active |
|
MP 6.058 |
Equipos médicos duraderos |
Intraocular Lenses, Spectacle Correction,and Iris Prosthesis |
Active |
|
MP 2.389 |
Medicine |
Active |
|
|
MP 2.030 |
Medicine |
Active |
|
|
MP 2.167 |
Medicine |
Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric Disorders |
Active |
|
MP 2.026 |
Medicine |
Active |
|
|
MP 4.005 |
Other Treatments |
Intravenous Chelation Therapy (Terapia de quelación intravenosa) |
Active |
|
MP 2.159 |
Medicine |
Active |
|
|
MP 2.278 |
Medicine |
Invasive Prenatal (Fetal) Diagnostic Testing (Pruebas diagnósticas prenatales (fetales) invasivas) |
Active |
|
MP 2.277 |
Medicine |
Active |
|
|
MP 8.001 |
Terapia |
Investigational Physical Medicine And Specialized Physical Medicine Interventions (Outpatient) |
Active |
|
MP 1.162 |
Cirugía |
Electroporación irreversible de tumores localizados en hígado, páncreas, riñón o pulmón |
Active |
|
MP 9.012 |
Trasplante |
Active |
|
|
MP 9.013 |
Trasplante |
Active |
|
|
MP 2.281 |
Medicine |
JAK2, MPL, and CLR Mutation Analysis in Myeloproliferative Neoplasms |
Active |
|
MP 2.309 |
Medicine |
Active |
|
|
MP 2.316 |
Medicine |
KRAS, NRAS, and BRAF Variant Analysis in Metastatic Colorectal Cancer |
Active |
|
MP 9.005 |
Trasplante |
Active |
|
|
MP 6.012 |
Equipos médicos duraderos |
Active |
|
|
MP 2.354 |
Medicine |
Active |
|
|
MP 7.027 |
OBGYN/Reproduction |
Active |
|
|
MP 4.047 |
Other Treatments |
Laser Treatment for Vulvovaginal Atrophy and Vaginal Rejuvenation |
Active |
|
MP 1.008 |
Cirugía |
Laser Treatment of Port Wine Stains (Tratamiento láser para las manchas de vino de Oporto) |
Active |
|
MP 2.046 |
Medicine |
Active |
|
|
MP 9.006 |
Trasplante |
Active |
|
|
MP 6.021 |
Equipos médicos duraderos |
Active |
|
|
MP 1.097 |
Cirugía |
Active |
|
|
MP 6.042 |
Equipos médicos duraderos |
Active |
|
|
MP 9.015 |
Trasplante |
Lung and Lobar Lung Transplant (Trasplante de pulmón y trasplante lobar de pulmón) |
Active |
|
MP 6.027 |
Equipos médicos duraderos |
Lysis of Epidural Adhesions (Lisis de adherencias epidurales) |
Active |
|
MP 1.145 |
Cirugía |
Active |
|
|
MP 5.053 |
Radiology/Imaging |
Active |
|
|
MP 5.011 |
Radiology/Imaging |
Magnetoencephalography/Magnetic Source Imaging (Magnetoencefalografía/Imagen de fuente magnética) |
Active |
|
MP 5.008 |
Radiology/Imaging |
Active |
|
|
MP 6.059 |
Equipos médicos duraderos |
Active |
|
|
MP 4.038 |
Other Treatments |
Active |
|
|
MP 6.022 |
Equipos médicos duraderos |
Mechanical Insufflation Exsufflation Device (Dispositivo de insuflación-exuflación mecánica) |
Active |
|
MP 6.039 |
Equipos médicos duraderos |
Active |
|
|
MP 6.064 |
Equipos médicos duraderos |
Active |
|
|
MP 4.003 |
Other Treatments |
Medical Necessity (Necesarios desde el punto de vista médico) |
Active |
|
MP 2.304 |
Medicine |
Active |
|
|
MP 2.090 |
Medicine |
Microwave Tumor Ablation (Ablación de tumores por microondas) |
Active |
|
MP 2.275 |
Medicine |
Active |
|
|
MP 2.275 |
Medicine |
Active |
|
|
MP 2.259 |
Medicine |
Active |
|
|
MP 2.377 |
Medicine |
Active |
|
|
MP 2.266 |
Medicine |
Molecular Testing for The Management of Pancreatic Cysts and Solid Pancreaticobiliary Lesions |
Active |
|
MP 2.375 |
Medicine |
Active |
|
|
MP 2.231 |
Medicine |
Active |
|
|
MP 2.387 |
Medicine |
Multicancer Early Detection Testing (Pruebas de detección temprana de cánceres múltiples) |
Active |
|
MP 2.315 |
Medicine |
Active |
|
|
MP 2.270 |
Medicine |
Active |
|
|
MP 5.054 |
Radiology/Imaging |
Active |
|
|
MP 2.094 |
Medicine |
Active |
|
|
MP 4.004 |
Other Treatments |
Active |
|
|
MP 8.012 |
Terapia |
Active |
|
|
MP 6.051 |
Equipos médicos duraderos |
Active |
|
|
MP 2.379 |
Medicine |
Active |
|
|
MP 3.009 |
Ancillary Services |
Active |
|
|
MP 7.026 |
OBGYN/Reproduction |
Active |
|
|
MP 2.261 |
Medicine |
Active |
|
|
MP 2.256 |
Medicine |
Noninvasive Prenatal Screening for Fetal Aneuploidies and Microdeletions Using Cell Free DNA |
Active |
|
MP 2.252 |
Medicine |
Active |
|
|
MP 2.071 |
Medicine |
Active |
|
|
MP 2.372 |
Medicine |
Occipital Nerve Stimulation (Estimulación del nervio occipital) |
Active |
|
MP 2.103 |
Medicine |
Active |
|
|
MP 4.019 |
Other Treatments |
Active |
|
|
MP 2.083 |
Medicine |
Active |
|
|
MP 2.056 |
Medicine |
Active |
|
|
MP 2.085 |
Medicine |
Active |
|
|
MP 2.066 |
Medicine |
Optical Diagnostic Devices for Evaluation of Skin Lesions Suspected of Malignancy |
Active |
|
MP 2.383 |
Medicine |
Orphan Drugs and Humanitarian Use Devices (Medicamentos huérfanos y dispositivos de uso humanitario) |
Active |
|
MP 1.101 |
Cirugía |
Active |
|
|
MP 4.039 |
Other Treatments |
Active |
|
|
MP 2.080 |
Medicine |
Active |
|
|
MP 2.005 |
Medicine |
Other Therapies of Hyperhidrosis (Otras terapias de la hiperhidrosis) |
Active |
|
MP 2.092 |
Medicine |
PENFS, CES, Auricular Electrostimulation, and External Trigeminal Nerve Stimulation |
Active |
|
MP 2.097 |
Medicine |
Active |
|
|
MP 6.024 |
Equipos médicos duraderos |
Pelvic Floor Stimulation as a Treatment of Urinary and Fecal Incontinence |
Active |
|
MP 2.397 |
Medicine |
Percutaneous Electrical Nerve Field Stimulation for Irritable Bowel Syndrome |
Active |
|
MP 6.050 |
Equipos médicos duraderos |
Active |
|
|
MP 1.124 |
Cirugía |
Active |
|
|
MP 1.134 |
Cirugía |
Active |
|
|
MP 1.141 |
Cirugía |
Active |
|
|
MP 1.109 |
Cirugía |
Active |
|
|
MP 1.143 |
Cirugía |
Active |
|
|
MP 2.218 |
Medicine |
Pharmacogenomic and Metabolite Markers for Patients Treated with Thiopurines |
Active |
|
MP 4.008 |
Other Treatments |
Active |
|
|
MP 9.001 |
Trasplante |
Active |
|
|
MP 4.031 |
Other Treatments |
Active |
|
|
MP 2.335 |
Medicine |
Active |
|
|
MP 5.008 |
Radiology/Imaging |
Positron Emission Mammography (Mamografía por emisión de positrones) |
Active |
|
MP 6.053 |
Equipos médicos duraderos |
Active |
|
|
MP 6.037 |
Equipos médicos duraderos |
Active |
|
|
MP 7.009 |
OBGYN/Reproduction |
Preimplantation Genetic Testing (Diagnóstico genético preimplantacional) |
Active |
|
MP 3.004 |
Ancillary Services |
Private Duty Nursing Services (Servicios de enfermería privados) |
Active |
|
MP 2.053 |
Medicine |
Active |
|
|
MP 2.061 |
Medicine |
Active |
|
|
MP 1.147 |
Cirugía |
Active |
|
|
MP 2.343 |
Medicine |
Proteogenomic Testing for Patients With Cancer (Pruebas proteogenómicas para pacientes con cáncer) |
Active |
|
MP 2.337 |
Medicine |
Active |
|
|
MP 1.084 |
Cirugía |
Active |
|
|
MP 1.055 |
Cirugía |
Active |
|
|
MP 2.033 |
Medicine |
Active |
|
|
MP 1.103 |
Cirugía |
Active |
|
|
MP 1.013 |
Cirugía |
Mamoplastía de reducción para síntomas relacionados con la mama |
Active |
|
MP 1.156 |
Cirugía |
Active |
|
|
MP 2.088 |
Medicine |
Active |
|
|
MP 1.033 |
Cirugía |
Active |
|
|
MP 5.021 |
Radiology/Imaging |
Active |
|
|
MP 2.176 |
Medicine |
Active |
|
|
MP 1.130 |
Cirugía |
Active |
|
|
MP 8.011 |
Terapia |
Active |
|
|
MP 2.222 |
Medicine |
Active |
|
|
MP 2.269 |
Medicine |
Active |
|
|
MP 1.094 |
Cirugía |
Active |
|
|
MP 2.241 |
Medicine |
Somatic Biomarker Testing (Including Liquid Biopsy) for Targeted Therapy in Non-Small Cell Lung |
Active |
|
MP 2.316 |
Medicine |
Somatic Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment in Metastatic Colorec |
Active |
|
MP 2.388 |
Medicine |
Somatic Biomarker Testing For Immune Checkpoint Inhibitor Therapy (MSIMMR, PD-L1, TMB) |
Active |
|
MP 2.316 |
Medicine |
Active |
|
|
MP 2.364 |
Medicine |
Active |
|
|
MP 8.002 |
Terapia |
Active |
|
|
MP 4.046 |
Other Treatments |
Active |
|
|
MP 1.069 |
Cirugía |
Active |
|
|
MP 6.063 |
Equipos médicos duraderos |
Active |
|
|
MP 2.089 |
Medicine |
Active |
|
|
MP 2.373 |
Medicine |
Active |
|
|
MP 1.140 |
Cirugía |
Active |
|
|
MP 2.345 |
Medicine |
Subcutaneous Hormone Pellet Implants (Implantes subcutáneos de pellets de hormonas) |
Active |
|
MP 1.114 |
Cirugía |
Active |
|
|
MP 1.163 |
Cirugía |
Active |
|
|
MP 1.129 |
Cirugía |
Surgical Treatment of Gynecomastia (Tratamiento quirúrgico de la ginecomastia) |
Active |
|
MP 1.082 |
Cirugía |
Surgical Treatment of Heart Failure (Tratamiento quirúrgico de la insuficiencia cardíaca) |
Active |
|
MP 1.128 |
Cirugía |
Active |
|
|
MP 1.161 |
Cirugía |
Tratamientos quirúrgicos para el linfedema relacionado con el cáncer de mama |
Active |
|
MP 2.053 |
Medicine |
Active |
|
|
MP 6.045 |
Equipos médicos duraderos |
Active |
|
|
MP 1.160 |
Cirugía |
Synthetic Cartilage Implants for the First Metatarsophalangeal Joint |
Active |
|
MP 2.066 |
Medicine |
Active |
|
|
MP 1.164 |
Cirugía |
Temporarily Implanted Nitinol Device (iTind) for Benign Prostatic Hyperplasia |
Active |
|
MP 2.062 |
Medicine |
Temporomandibular Joint Disorder (Trastorno de la articulación temporomandibular) |
Active |
|
MP 6.061 |
Equipos médicos duraderos |
Therapeutic Shoes for Persons with Diabetes (Zapatos terapéuticos para personas con diabetes) |
Active |
|
MP 1.086 |
Cirugía |
Active |
|
|
MP 5.017 |
Radiology/Imaging |
Active |
|
|
MP 6.046 |
Equipos médicos duraderos |
Active |
|
|
MP 1.134 |
Cirugía |
Active |
|
|
MP 1.026 |
Cirugía |
Active |
|
|
MP 6.020 |
Equipos médicos duraderos |
Transcutaneous Electrical Nerve Stimulation and Transcutaneous Afferent Patterned Stimulation |
Active |
|
MP 2.053 |
Medicine |
Active |
|
|
MP 1.057 |
Cirugía |
Transmyocardial Revascularization (Revascularización transmiocárdica) |
Active |
|
MP 4.034 |
Other Treatments |
Active |
|
|
MP 1.061 |
Cirugía |
Treatment of Varicose Veins - Venous Insufficiency (Tratamiento de varices - Insuficiencia venosa) |
Active |
|
MP 1.061 |
Cirugía |
Active |
|
|
MP 2.072 |
Medicine |
Trigger Point and Tender Point Injections (Inyecciones de puntos gatillo y puntos sensibles) |
Active |
|
MP 6.054 |
Equipos médicos duraderos |
Tumor Treating Fields Therapy (Terapia de campos de tratamiento de tumores) |
Active |
|
MP 6.021 |
Equipos médicos duraderos |
Active |
|
|
MP 6.052 |
Equipos médicos duraderos |
Active |
|
|
MP 2.249 |
Medicine |
Active |
|
|
MP 1.034 |
Cirugía |
Active |
|
|
MP 1.146 |
Cirugía |
Active |
|
|
MP 2.065 |
Medicine |
Vertebral Axial Decompression (Descompresión axial vertebral) |
Active |
|
MP 5.046 |
Radiology/Imaging |
Active |
|
|
MP 1.136 |
Cirugía |
Vertical Expandable Prosthetic Titanium Rib (Costilla protésica vertical expansible de titanio) |
Active |
|
MP 4.007 |
Other Treatments |
Active |
|
|
MP 5.037 |
Radiology/Imaging |
Active |
|
|
MP 2.324 |
Medicine |
Active |
|
|
MP 5.033 |
Radiology/Imaging |
Active |
|
|
MP 4.028 |
Other Treatments |
Active |
|
|
IC-0610NC |
Retiradas |
||
|
MP 2.036 |
Medicine |
Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry (Retired 4/1/2025) |
Retiradas |
|
Retiradas |
|||
|
MP 2.359 |
Medicine |
Análisis de metilación de promotor MGMT en gliomas malignos (retirado el 1/1/2024) |
Retiradas |
|
IC-0356 |
Retiradas |
||
|
MP 1.002 |
Cirugía |
Retiradas |
|
|
MP 2.099 |
Medicine |
Automated Point of Care Nerve Conduction Tests (Retired 1/1/2025) |
Retiradas |
|
MP 2.100 |
Medicine |
Retiradas |
|
|
MP 1.017 |
Cirugía |
Sustitutos de piel y tejidos blandos creados a partir de la bioingeniería (retirado el 4/1/2024) |
Retiradas |
|
IC-0561 |
Retiradas |
||
|
MP 2.370 |
Medicine |
Retiradas |
|
|
MP 1.122 |
Cirugía |
Retiradas |
|
|
MP 2.271 |
Medicine |
Retiradas |
|
|
MP 2.007 |
Medicine |
Cardiac Intervention Therapy for the Treatment of Heart Failure (Retired 4/1/2025) |
Retiradas |
|
MP 8.005 |
Terapia |
Cardiac Rehabilitation In The Outpatient Setting (Retired 9/1/2025) |
Retiradas |
|
MP 1.081 |
Cirugía |
Cardioverter Defibrillators (Implantable and External) (Retired 4/1/2025) |
Retiradas |
|
MP 8.007 |
Terapia |
Retiradas |
|
|
MP 1.106 |
Cirugía |
Computer Assisted Navigation for Orthopedic Procedures (retired 9/1/2024) |
Retiradas |
|
MP 4.048 |
Other Treatments |
Retiradas |
|
|
MP 2.380 |
Medicine |
Diagnosis and Treatment of Post Acute COVID (PASC) (Retired 8/1/2025) |
Retiradas |
|
MP 3.016 |
Ancillary Services |
Retiradas |
|
|
MP 6.048 |
Equipos médicos duraderos |
Retiradas |
|
|
MP 2.032 |
Medicine |
Retiradas |
|
|
MP 1.149 |
Cirugía |
Endovascular Therapies for Extracranial Vertebral Artery Disease (Retired 4/1/2025) |
Retiradas |
|
MP 2.014 |
Medicine |
Retiradas |
|
|
IC-0357 |
Epoetin alfa: Epogen®; Procrit®; Retacrit® (Retired 11/1/2023) |
Retiradas |
|
|
MP 2.016 |
Medicine |
Retiradas |
|
|
Retiradas |
|||
|
MP 2.369 |
Medicine |
Retiradas |
|
|
MP 1.152 |
Cirugía |
Functional Endoscopic Sinus Surgery for Chronic Rhinosinusitis (Retired 7/1/2025) |
Retiradas |
|
AHS M2058 |
Pruebas genéticas para la escoliosis idiopática en adolescentes (retirado el 10/1/2023) |
Retiradas |
|
|
MP 2.361 |
Medicine |
Genetic Testing for Statin-Induced Myopathy (Retired 5/1/2025) |
Retiradas |
|
MP 2.279 |
Medicine |
Retiradas |
|
|
Retiradas |
|||
|
MP 7.019 |
OBGYN/Reproduction |
Retiradas |
|
|
MP 5.047 |
Radiology/Imaging |
Retiradas |
|
|
MP 1.151 |
Cirugía |
Dispositivos de fijación interespinosa (fusión) (retirado el 11/1/2023) |
Retiradas |
|
MP 4.013 |
Other Treatments |
Retiradas |
|
|
MP 2.146 |
Medicine |
Retiradas |
|
|
MP 1.127 |
Cirugía |
Retiradas |
|
|
MP 4.024 |
Other Treatments |
Retiradas |
|
|
MP 8.006 |
Terapia |
Retiradas |
|
|
MP 2.329 |
Medicine |
Medición de anticuerpos séricos frente agentes biológicos seleccionados (retirado el 7/1/2023) |
Retiradas |
|
MP 2.303 |
Medicine |
Retiradas |
|
|
IC-0359 |
Retiradas |
||
|
MP 2.377 |
Medicine |
Retiradas |
|
|
MP 2.231 |
Medicine |
Retiradas |
|
|
MP 2.330 |
Medicine |
Retiradas |
|
|
MP 5.054 |
Radiology/Imaging |
Myocardial Sympathetic Innervation Imaging in Patients with Heart Failure (Retired 6/1/2024) |
Retiradas |
|
MP 4.027 |
Other Treatments |
Neuropsychological Testing for Medical Purposes (Retired 7/1/2025) |
Retiradas |
|
MP 2.256 |
Medicine |
Retiradas |
|
|
MP 8.004 |
Terapia |
Retiradas |
|
|
MP 3.015 |
Ancillary Services |
Procedimientos en consultorio realizados en un centro (retirado el 10/1/2023) |
Retiradas |
|
MP 2.385 |
Medicine |
Retiradas |
|
|
MP 8.008 |
Terapia |
Retiradas |
|
|
MP 1.116 |
Cirugía |
Retiradas |
|
|
IC-0595 |
Retiradas |
||
|
MP 3.004 |
Ancillary Services |
Retiradas |
|
|
MP 1.154 |
Cirugía |
Retiradas |
|
|
MP 4.009 |
Other Treatments |
Procedures of Questionable Current Usefulness (Retired 6/1/2025) |
Retiradas |
|
MP 6.018 |
Equipos médicos duraderos |
Retiradas |
|
|
MP 2.095 |
Medicine |
Retiradas |
|
|
MP 5.022 |
Radiology/Imaging |
Retiradas |
|
|
MP 4.049 |
Other Treatments |
Retiradas |
|
|
MP 6.060 |
Equipos médicos duraderos |
Retiradas |
|
|
MP 2.086 |
Medicine |
Retinal Telescreening for Diabetic Retinopathy (Retired 1/1/2026) |
Retiradas |
|
MP 6.032 |
Equipos médicos duraderos |
Retiradas |
|
|
MP 4.032 |
Other Treatments |
Suministro de agentes farmacológicos en el espacio supracoroideo (en vigencia a partir del 2/1/2024) |
Retiradas |
|
MP 2.057 |
Medicine |
Retiradas |
|
|
MP 4.044 |
Other Treatments |
Retiradas |
|
|
AHS – M2141 |
Pruebas de afecciones relacionadas con el metabolismo de la homocisteína (retirado el 5/1/2023) |
Retiradas |
|
|
MP 1.135 |
Cirugía |
Transcatheter Aortic Valve Implantation for Aortic Stenosis (Retired 4/1/2025) |
Retiradas |
|
MP 1.153 |
Cirugía |
Retiradas |
|
|
MP 1.139 |
Cirugía |
Transcatheter Pulmonary Valve Implantation (Retired 4/1/2025) |
Retiradas |
|
MP 2.382 |
Medicine |
Treatment for Duchenne Muscular Dystrophy (Retired 1/1/2025) |
Retiradas |
|
MP 1.095 |
Cirugía |
Treatment of Menieres and Sudden Hearing Loss (Retired 8/1/2025) |
Retiradas |
|
MP 2.038 |
Medicine |
Retiradas |
|
|
MP 2.078 |
Medicine |
Ultrafiltration in Decompensated Heart Failure (Retired 4/1/2025) |
Retiradas |
|
MP 5.036 |
Radiology/Imaging |
Retiradas |
|
|
Retiradas |
|||
|
AHS – G2133 |
Evaluación del riesgo del virus ZIKA (retirado el 11/1/2023) |
Retiradas |
|
|
MP 2.143 |
Medicine |
Retiradas |
|
|
MP 2.010 |
Medicine |
Retiradas |
|
|
MP 3.008 |
Ancillary Services |
Retiradas |
|
|
MP 2.371 |
Medicine |
Therapeutic Radiopharmaceuticals for Neuroendocrine Tumors (Retired 2/1/2026) |
Retiradas |
|
MP 2.208 |
Medicine |
Retiradas |