Medical fees
The WPA Fee Schedule details the maximum amount we will pay towards the specialist and anaesthetist charges for consultations or procedures.
Schedule of fees
We reimburse recognised specialists for consultations and procedures up to the maximum amount as set out here in our WPA Fee Schedule.
Consultations and operations (procedures) are classified using CCSD (Coding, Classification and Schedule Development) codes. These are listed in the WPA Fee Schedule, which details the maximum amount we will pay towards the fee your specialist and anaesthetist will charge for your consultation or for your operation/procedure. It is important that specialists discuss fees with their patients, so if the specialist fees are more than WPA's allowance then any shortfall to the patient can be considered before you book your consultation or before treatment commences.
Important information
CCSD also provide guidance on codes that are not intended to be billed in conjunction with one another, to avoid overlap or unbundling of fees, when being billed by a specialist, anaesthetist or hospital. WPA works to this guidance.
For acceptable multiple procedure code combinations WPA will pay benefit in line with the following:
Surgeon and anaesthetist fees
| First procedure | Up to 100% of the listed maximum fee |
| Second procedure | Up to 50% of the listed maximum fee |
| Third and subsequent procedures | Up to 25% of the listed maximum fee for each |
Hospital fees
Multiple procedures will be paid in accordance with pre-agreed multiple procedure criteria.
When an operation/procedure is needed, the specialist should provide the patient with the code/s along with the fees they intend to charge. WPA can then confirm whether fees will be met in full before the commencement of treatment.
It is an absolute condition for all specialists who are recognised by WPA to provide patients with written details of their fees in advance of treatment taking place.
In the event that a patient is not reasonably advised of fees (in writing), and there is a shortfall they have not agreed to, we reserve our right to support the patient in resisting demands for any additional payment. For more information, please visit our Terms of Recognition.
WPA aim to include all CCSD codes within the WPA Fee Schedule, which is regularly updated. The inclusion of codes on this website provides no guarantee the procedure is eligible for benefit and so all procedures must be pre-authorised with WPA.
Routine pre and post-operative in-patient care is deemed to be included in the procedure benefit.
Attendance fee benefit during in-patient care of medical cases is payable to the admitting specialist according to the severity of the illness of the patient up to the time of discharge or transfer to another specialist. This will only be considered for one primary specialist per day.
Additional consultation fee benefit may be payable to other specialists called in for specific medical problems.
Intensive care benefit is payable to recognised intensive care specialists on a daily basis to include the insertion of all lines, catheters and monitoring equipment. Procedure fee benefit or specialist's consultation fee benefit will be payable in addition, when required for specific expertise in the care of the patient.
Intensive care will only be covered for a maximum of 28 days in any one year.
Assistant fee benefit is not payable for a procedure traditionally performed by a single qualified specialist.
Where a procedure necessitates more than one discipline, and a second approved consultant specialist is required for best practice, WPA may consider a fee benefit supplement subject to pre-authorisation.
Please contact our Centre for Clinical Excellence Team on 01823 625260.
Routine arrangements should be in place to identify patients who have an increased risk of complications and morbidity/ mortality. For instance, early discussion between specialist and anaesthetist after initial surgical consultation.
WPA expects that all patients will be assessed pre-operatively by an anaesthetist. This may typically be on the day of surgery. The cost is included in our current fee structure for anaesthetists.
WPA does not routinely pay for separate pre-operative consultations for any procedure although recognises that in certain circumstances it is necessary for a patient to been seen formally by an anaesthetist as a separate pre-operative consultation.
WPA will only consider funding such a consultation if it has been pre-authorised by us following receipt of a detailed summary and risk assessment, and also that the cost of the consultation is made clear to the patient in advance.