Medical Policies

WPS’ Medical Policies state WPS’ policy regarding the medical necessity of a procedure or other service and whether the procedure or technology is considered experimental or investigational. The policies are one tool used for making benefit coverage decisions under WPS administered health policies or plans. Benefits vary in coverage and some health policies or plans may not provide coverage for procedures or services addressed in the Medical Policies. When making coverage decisions, WPS staff utilizes the customer’s health policy or plan benefit document, Medical Policies, and other guidelines approved by a WPS Medical Director.

WPS’ Medical Policies are based on peer-reviewed scientific literature, evidence-based consensus guidelines from national professional organizations, medical textbooks, and expert opinions from WPS consultants. The Medical Policies are then reviewed by the WPS Physician Advisory Committee who advise the WPS Medical Director regarding the appropriateness of the criteria.

Medical Policies can be technical and are provided for informational purposes only. The Medical Policies should not be considered medical advice. Physicians and other health care providers are solely responsible for the diagnosis, treatment, and medical recommendations regarding a customer’s condition. All WPS customers are advised to review the Medical Policies with their physicians to ensure they are fully understood.

Medical procedures and technology are continually evolving and these Medical Policies are subject to change without prior notice. Occasionally, new Medical Policies are added, while others may be retired. WPS recommends that this site be periodically reviewed for changes.

WPS welcomes your feedback regarding the criteria in the Medical Policies. Comments regarding specific criteria should include supporting references from peer-reviewed scientific literature. Please respond to medical.policies@wpsic.com.