Medical Policies

Medical policies are guidelines used to determine coverage for specific medical technologies, procedures, equipment and services. These policies state whether a procedure, biologic, treatment/therapy, or device is or is not medically necessary or investigational. Medical policies are based on proven merits and credible scientific evidence.

We take this role very seriously and understand that it can be confusing and may be frustrating to find out a certain service or procedure isn’t covered. We encourage you to work with your health care provider to explore options and reach out to us with questions or concerns, by calling the customer service number on the back of your ID card.

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

We base our medical policies on:

Data from credible scientific evidence published in peer-reviewed medical literature
National medical society position statements or guidelines and applicable governmental reports

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. 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 removed from use.

Policies starting with A

Policies starting with B

Policies starting with C

Policies starting with D

Policies starting with E

Policies starting with F

Policies starting with G

Policies starting with H

Policies starting with I

Policies starting with K

Policies starting with L

Policies starting with M

Policies starting with N

Policies starting with O

Policies starting with P

Policies starting with Q

Quantitative Sensory Testing PDF File

Policies starting with R

Policies starting with S

Policies starting with T

Policies starting with U

Policies starting with V

Policies starting with W

Policies starting with Y

Yescarta (Axicabtagene Ciloleucel)* PDF File

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.