Políticas médicas y de pago

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Draft Medical and Payment Policies
Percutaneous Electrical Nerve Field Stimulator System for Functional Abdominal Pain Disorders (IB-Stim), Effective 01/1/2025
Plasma-Based Genomic Profiling (Liquid Biopsy) in Solid Tumors, Effective 03/1/2025
Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer
Médico
Paraspinal Surface Electromyography (SEMG) to Evaluate and Monitor Back Pain
Patient-Controlled End of Range Motion Stretching Devices
Pelvic Floor Stimulation as a Treatment of Urinary and Fecal Incontinence
Pelvic Floor Stimulation as a Treatment of Urinary and Fecal Incontinence, Effective 01/1/2025
Percutaneous Electrical Nerve Stimulation, Percutaneous Neuromodulation Therapy, and Restorative Neurostimulation Therapy
Peripheral Subcutaneous Field Stimulation
Peroral Endoscopic Myotomy for Treatment of Esophageal Achalasia
Phototherapeutic Keratectomy
Phototherapy for the Treatment of Seasonal Affective Disorder
Phototherapy in the Home for the Treatment of Dermatological Conditions
Phrenic Nerve Stimulation for Central Sleep Apnea
Plugs for Anal Fistula Repair
Post-Partum Hospital Stays Mandate
Powered Exoskeleton for Ambulation in Patients with Lower-Limb Disabilities
Progenitor Cell Therapy for the Treatment of Damaged Myocardium due to Ischemia
Prostatic Stent - Temporary
Proteomic Testing for Targeted Therapy in Non-Small-Cell Lung Cancer
Pulsed Radiofrequency for the Treatment of Chronic Pain
Payment
PANDAS and PANS
Payment Adjustments for Serious Reportable Events (also known as SRE or Never Events) and Hospital Acquired Conditions
Payments for Outpatient Service Performed when a Member is Admitted as an Inpatient to a Different Hospital
Pharmacy Prescription Early Refill
Physical and Occupational Therapy
Physical and Occupational Therapy Payment Cap
Physician Concierge Services
Place of Service (POS) 10 Telemedicine
Post Payment Audits
Pre-Payment Review Process
Preventive Medicine and Other Evaluation and Management Office/Outpatient Services
Preventive Services for Commercial Members
Preventive Services for Medicare Advantage Plans
Professional Reporting Requirements for Services Not Personally Performed (AKA Incident to Services)
Prolonged Physician Services
Prostate Specific Antigen (PSA) Screening/Testing Mandate
Provider Credentialing and Recredentialing Process
Provider Guidelines for Requesting Point of Service Payment and Maintaining Patient Credit Card Information
Psychological and Neuropsychological Testing
Autorización previa
Pediatric Dental Services Essential Health Benefit -Dental Review
Pediatric Dental Services- Essential Health Benefit, Effective 01/1/2025
Percutaneous and Subcutaneous Tibial Nerve Stimulation
Percutaneous Left Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation
Peripheral Artery Disease (PAD) Rehabilitation
Peripheral Artery Disease (PAD) Rehabilitation, Effective 01/1/2025
Preimplantation Genetic Testing
Prior Authorization of Cardiology and Radiology Services
Prior Authorization of Drugs
Prior Authorization of Spinal Procedures
Prior Authorization via Web-Based Tool for Durable Medical Equipment (DME)
Prior Authorization via Web-Based Tool for Durable Medical Equipment (DME), effective 03/1/2025
Prior Authorization via Web-Based Tool for Durable Medical Equipment (DME), Effective 04/1/2025
Prior Authorization via Web-Based Tool for Procedures
Prior Authorization via Web-Based Tool for Procedures, Effective 01/1/2025
Prior Authorization via Web-Based Tool for Procedures, Effective 02/1/2025
Prior Authorization via Web-Based Tool for Procedures, Effective 03/1/2025
Private Duty Nursing
Progesterone Therapy as a Technique to Reduce Preterm Birth in High-Risk Pregnancies
Prognostic and Predictive Molecular Classifiers for Bladder Cancer
Proprietary Laboratory Analyses (PLA) and Multianalyte Assays with Algorithmic Analyses (MAAA)
Proprietary Laboratory Analyses (PLA) and Multianalyte Assays with Algorithmic Analyses (MAAA) - Effective 01/1/2025
Proprietary Laboratory Analyses (PLA) and Multianalyte Assays with Algorithmic Analyses (MAAA) - Effective 03/1/2025
Prostate Cancer Detection with IsoPSA
Prostatic Urethral Lift
Proteogenomic Testing for Patients with Cancer