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Response to Comments: Cosmetic and Reconstructive Surgery DL39051
A59903
Wisconsin Physicians Service Insurance Corporation (J05)
Effective: October 13, 2024
Updated: December 31, 2025
Policy Summary
This notice reports that WPS received no comments on the Cosmetic and Reconstructive Surgery policy DL39051 and does not contain substantive coverage criteria or changes. For specific indications, limitations, documentation requirements, and frequency limits, consult DL39051 (the referenced policy).
Coverage Criteria Preview
Key requirements from the full policy
"This notice states WPS received no comments on Cosmetic and Reconstructive Surgery DL39051; consult policy DL39051 for the actual coverage criteria and any documentation requirements."
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