Medical Policies are developed to assist in making coverage determinations under our health policies or plans. If you are looking for, or wish to comment on, the Medical Policy guidelines for a patient covered by Medicare, go to the WPS Government Health Administrators website.
Medical Policies are for informational purposes only and do not constitute medical advice, plan authorization, an explanation of benefits, or a guarantee of payment. Benefit plans vary in coverage and some plans may not provide coverage for all services listed in these policies. Coverage decisions are subject to all terms and conditions of the applicable benefit plan, including specific exclusions and limitations, and to applicable state and federal law. Some benefit plans administered by the organization may not utilize Medical Affairs Medical Policies in all their coverage determinations. Contact Member Services as listed on the member card for specific plan, benefit, and network status information.
Medical Policies are based on constantly changing medical science and are reviewed annually and subject to change. The organization uses tools developed by third parties, such as the evidence-based clinical guidelines developed by MCG Health, to assist in administering health benefits. These medical policies and MCG Health guidelines are intended to be used in conjunction with the independent professional medical judgment of a qualified health care provider.
For specific patient-related policy or medical coding inquiries, please contact WPS Medical Affairs at 800-333-5003 with the applicable patient name and member number, along with the procedure, service, or treatment in question.
We welcome your feedback regarding criteria in the Medical Policies or MCG Health guidelines. Comments regarding research and evidence development of specific criteria should include supporting references from peer-reviewed, high-level scientific literature. Please send your comments to email@example.com.
For general medical policy or MCG Health information, email the Medical Policy Committee: firstname.lastname@example.org.
For questions regarding medical coding related to policies, contact the Code Governance Committee: email@example.com.
This disclaimer applies to all present and past Medical Policies.