Welcome to the WPS GHA "Policy" web Page. Use the left-hand or top navigation to access the information you are looking for.
Did you know that you can easily launch an e-mail directly to our entire Policy staff simply by choosing the applicable e-mail link located directly on many of our policy web pages? WPS GHA encourages providers to be involved in the Policy process. Whether it's a question or comment on a draft policy, or a request for reconsideration, don't miss your chance to provide valuable information and to assist us in publishing clear, concise, fair and accurate policies. We look forward to hearing from you!
WPS GHA divides J5 MAC Active Polices into Local Policies and National Policies.
CMS and WPS GHA develop policies to help ensure proper Medicare payments. Providers use the policies to verify coverage of a procedure or service.
WPS GHA 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 eNews by selecting the eNews link in the top right corner to receive the most current policy changes. Please check the Training Schedule for educational opportunities on a specific policy or topic.
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.
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, Self-Administered Drug Exclusion List (SAD List).
News & Highlights
- Trabectedin/Yondelis Coverage
- For an index of Laboratory NCDs, please see: https://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx