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Medical policies are guidelines used to determine coverage for specific medical technologies, procedures, equipment and services. These policies state whether a procedure, biologic, or device is not medically necessary or investigational.

To search for medical policies, view our alphabetical listing of Medical Policies.

We base our medical policies on:
  • Data from peer-reviewed scientific literature
  • National medical society statements or guidelines and applicable governmental reports
  • Guidelines adopted by other health care organizations
We use the following criteria to evaluate medical technologies:
  • The technology must have final approval from the appropriate governmental regulatory bodies
  • The scientific evidence must permit conclusions concerning the effect of technology on health outcomes
  • The technology must improve the net health outcomes
  • The technology must be as beneficial as any established alternatives
  • The improvement must be obtainable outside the investigational settings

Medical technology is constantly evolving. Hence, our medical policies are subject to change without notice, except as required by law. Additional medical policies may be developed from time to time, and some may be withdrawn from use.

Wellmark's medical policies address the complex issue of technologically assessing new and emerging treatments, devices, drugs, etc. Policies are developed to assist in the administration of plan benefits and are not offers of medical coverage or advice. They contain only a partial, general description of plan or program benefits and do not constitute a contract. Wellmark does not provide medical treatment and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Wellmark or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. Our medical policies are subject to change without notice.