News & Updates

News and updates for Medical Providers

Coverage decision revision - treatment of migraine (Retroactive to original effective date of December 1, 2017) (Posted September 14, 2018)
L&I revised the coverage decision on treatment of chronic migraine and chronic tension-type headache due to an amendment made by the Health Technology Clinical Committee recently. The second requirement of the discontinuation criteria is removed. The effective date of the revised decision is retroactive to the original effective date of December 1, 2017.


Coverage decision update - pharmacogenomic testing. (Effective November 1, 2018) (Posted September 10, 2018)
L&I has updated the coverage decision on pharmacogenomic testing according to a recent Health Technology Clinical Committee coverage determination about pharmacogenomic testing for patients treated with oral anticoagulants.


Coverage decision on surgery for lumbar radiculopathy/sciatica (Effective November 1, 2018) (Posted August 30, 2018)
L&I has adopted a Health Technology Clinical Committee coverage determination about surgery for lumbar radiculopathy/sciatica, effective on November 1, 2018.


Coverage decision - Gene expression profile testing of cancer tissue. (Effective October 1, 2018) (Posted August 30, 2018)
L&I has adopted a Health Technology Clinical Committee coverage determination on gene expression profile (GEP) testing of cancer tissue. Effective on October 1, 2018, GEP testing of breast cancer tissue and prostate cancer tissue is a covered benefit with conditions. However, GEP testing of multiple myeloma and of colon cancer tissue is not covered.


Coverage decision on therapeutic genicular nerve blocks for chronic knee pain. (Effective October 1, 2018) (Posted August 20, 2018)
L&I made a coverage decision on therapeutic genicular nerve blocks recently. Genicular nerve block for treating chronic knee pain is not a covered benefit.


Coverage Policy for Sacroiliac (SI) Joint Fusion. (Effective June 1, 2018)
An interim coverage policy for SI joint fusion has been published and is effective as of June 1, 2018. The policy formalizes criteria that was being applied by utilization review. Care coordination is required to be in place prior to surgical approval. An evidence-based review of this and other spine procedures is anticipated by the Industrial Insurance Medical Advisory Committee in early 2019.

 


Continuous glucose monitoring (CGM). (Effective July 1, 2018)
L&I has determined that the Health Technology Clinical Committee (HTCC) decision to cover CGM does not apply to Washington’s workers’ compensation because diabetes is not typically work related, and therefore does not meet the definition of an industrial injury or occupational disease.


Genomic microarray. (Effective July 1, 2018)
L&I has determined that the Health Technology Clinical Committee (HTCC) decision to cover genomic microarray for diagnosing genetic abnormalities in children does not apply to Washington’s workers’ compensation, which only covers work-related injuries or occupational disease.


Expanded Shoulder Conditions Diagnosis and Treatment Guideline. (Effective May 1, 2018)
An expanded Guideline for Diagnosis and Treatment of Shoulder Conditions has been published and is effective as of May 1, 2018. The expansion adds coverage criteria for Superior Capsular Reconstruction, a relatively new salvage procedure for irreparable rotator cuff repairs. This procedure is reserved for tears that cannot physically be repaired, or that will predictably fail. Review by a physician is required.


Coverage decision on Selected Treatments for Varicose Veins. (October 31, 2017)
L&I has adopted a Health Technology Clinical Committee coverage decision on treatments for varicose veins. Effective on December 1, 2017, the selected treatments are covered benefits with conditions.


Coverage decision on Treatment of Chronic Migraine and Chronic Tension-type Headache. (October 31, 2017)
L&I has adopted a Health Technology Clinical Committee coverage decision on treatment of chronic migraine and chronic tension-type headache.  Effective on December 1, 2017, OnabotulinumtoxinA for treatment of chronic migraine is a covered benefit with conditions, however, OnabotulinumtoxinA is not covered for treatment of chronic tension-type headache.


Miss the Attending Doctors’ Handbook? (October 24, 2017)
It has been redesigned as an online Attending Provider Resource Center (version 1.0)!  You can find this under Provider Tools on the Medical Provider page of L&I’s website. This is only version 1.0; new sections and hyperlinks will be added as they become available. The sections are brief, providing only context explaining how the topics are relevant for attending providers, with hyperlinks that direct you to more detailed information. In this way, we can keep information current and not duplicate what is already elsewhere on L&I’s web site. There is even a hyperlink for you to provide us with direct feedback. And be sure to view the welcoming video by our Medical Director, Gary Franklin MD!


 

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