Coverage of Conditions and Treatments (Coverage Decisions)

Use this lookup tool to determine coverage decisions, or if prior authorization is needed for the treatment or condition. Note: For Self-insured employer claims, you must contact the employer or their claims administrator.

List also available in PDF format.

Archived Coverage Decisions.

See Treatment Guidelines and Resources for additional information.

Acupuncture* is a covered benefit with conditions for chronic migraine when that is an accepted condition on their workers’ compensation claim.

Conditions of coverage

This decision applies to adults (age 18 and older) for chronic migraine (as defined by the International Headache Society**). Acupuncture is a covered benefit with the following conditions:

• Must be diagnosed with chronic migraine by a qualified provider (per Washington State Department of Health),
• With a referral by the attending provider,
• Up to 24 sessions over the course of one year, and
• One additional treatment cycle may be considered at agency discretion; the agency may authorize up to 24 additional sessions that may occur any time after the completion of the initial, effective cycle, when the following criteria are met:
  • Referred by the attending provider, and
  • Individual has shown a significant improvement in symptoms on a validated scale for chronic migraine with the initial treatment cycle (e.g., a change of ≥ 4.5 points in the Migraine Disability Assessment Score [MIDAS] or a decrease of ≥6 points in the Headache Impact Test [HIT-6] Total Scores).

• Out of scope /data not reviewed for this decision:
  • Other headache and migraine types not specified 

Other Acupuncture Coverage Decisions:

Background Information