Medical Policies


WSI has developed medical policies for certain medical/surgical services for use in utilization review, claim management, and bill audit processes. Each policy includes a treatment guideline primarily based on ODG by MCG or a documentation guideline primarily based on Centers for Medicare and Medicaid Services (CMS). WSI may incorporate other resources into the development of a policy as appropriate. A medical provider should be familiar with the policies and follow the recommendations.

Billing Therapeutic Activities

Cervical Epidural Steroid Injection

Chronic Opioid Therapy

Definitive Drug Testing

Documentation Requirements for Prior Authorization of Therapeutic Injections

Evaluation and Management

Falsified Medical Records

Lumbar Fusion Surgery

Ongoing Management of Opioids

Physical and Occupational Therapy Documentation

Physical Medicine and Rehabilitation Time-Based Services

Prior Authorization for Brand Necessary Medications

Sacroiliac Injections (Diagnostic and Therapeutic)

Spinal Cord Stimulators for Pain

Vasopneumatic Device Modality