Policies/Coverage

Welcome to the WPS Medicare “Polices/Coverage” Web Page. Use the left-hand or top navigation to access the information you are looking for.

J5 MAC Active Policies

WPS Medicare divides J5 MAC Active Polices into Local Policies and National Policies.

CMS and WPS Medicare develop policies to help ensure proper Medicare payments. Providers use the policies to verify coverage of a procedure or service.

WPS Medicare has a staff of physicians and registered nurses responsible for developing, monitoring, and updating policies. The policy staff is dedicated to helping Medicare beneficiaries as well as providing Medicare providers medical necessity reimbursement guidance.

The policy staff works closely with Provider Outreach and Education (POE) to ensure timely and accurate policy education is provided. Sign up for e-News to receive the most current policy changes. Please check the Training Schedule for educational opportunities on a specific policy or topic.

J5 MAC Draft Policies

Open Meetings

WPS will hold an open Local Coverage Determinations (LCD) meeting for persons wishing to provide input concerning LCDs that are currently in the development process. We will provide the date, time, and call in number of the meeting in advance. The meetings allow submission of scientific evidence and other information from members of the general public relating to the draft policies.

Usually Self-Administered Drugs

The Medicare program provides for coverage of outpatient prescription drugs as a limited benefit. The drugs are covered if given “incident to” a physician’s service and provided the drugs are not usually self-administered. For more information on Usually Self Administered Drugs, use the left hand navigation, Usually Self-Administered Drugs.

Page Last Updated: Friday, 06-Nov-2009 14:07:54 CST