Does WPS Medicare require prior authorization or prior approval for any services?
No. While a proposed treatment plan could offer insight into a patient’s condition, the actual service and follow-up care provided may differ based on the patient’s condition at the time the service is rendered. For this reason, the original Medicare program does not give prior authorization or prior approval for any service. You can find general coverage guidelines for many services using the Medicare Coverage Database (MCD). This searchable database, which is maintained by the Centers for Medicare & Medicaid Services (CMS), is located on the CMS Website at the following address: http://www.cms.hhs.gov/mcd Providers can also find WPS Medicare’s coverage and billing guidelines for many services using our Local Coverage Determinations (LCDs). You can locate our policies on our Website. In the absence of a local or national coverage policy, WPS Medicare determines whether coverage is available for a service on a case-by-case basis using the documentation submitted with the claim for paym
