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.

Occupational Health Best Practices and L&I header

The gold standard treatment for Traumatic Brain Injury is multidisciplinary rehabilitation. Brain Injury Rehabilitation Programs (BIRPs) are outpatient programs that deliver regularly scheduled, comprehensive, interdisciplinary, worker-centered care for all patients with brain injury including concussion. There is a half day program (minimum of 4 hours per day) and a full day program (minimum of 6 hours per day). The medical services provided are coordinated, integrated, goal-directed, and team-based.

Early referral to BIRP ensures workers with TBI receive a holistic approach to treatment and optimizes the effectiveness. BIRP model is flexible to meet patient needs.

BIRP has three phases:

  • Evaluation Phase - This phase consists of a comprehensive multidisciplinary evaluation of the worker’s cognitive, psychological, emotional, social, physical status and functioning. It includes the review of the workers’ medical records, assessment of any important associated conditions that may hinder recovery, identification of the worker’s family and support resources, and identification of other factors that may affect participation.
  • Treatment Phase - This phase provides comprehensive, coordinated, individualized worker-centered interdisciplinary treatment for brain injury. Based on the symptoms of the worker, the treatment phase can include intensive treatment focusing on headaches and neurological, vestibular, musculoskeletal, optometric, sleep, and audiologic complaints. Treatment includes physical therapy, vestibular therapy, occupational therapy, and cognitive rehabilitation. A core component of the program is patient and family education on understanding TBI, TBI pathology, behavioral modification, and operational stressors to promote long term self-efficacy and self-advocacy. The program also includes education and training on sleep hygiene and nutrition.
  • Follow-up Phase - This phase includes transitioning the worker back to the community, coordinating with attending provider and maintaining functional improvements.

Conditions of Coverage

BIRP requires a referral from the AP and prior authorization from the claim manager and occupational nurse consultant. BIRP treatment may be authorized if all the following are met:

  • The insurer has allowed brain injury as an accepted condition under the claim, or treatment authorized as aid to recovery,
  • The worker is physically, emotionally, cognitively and psychologically capable of full participation in the rehabilitation program,
  • The evaluation done by the brain injury program demonstrates the worker is capable of new learning, and
  • The evaluation report by the program identifies specific goals to help the worker improve function or compensate for lost function

For additional requirements and current policy, see MARFS Chapter 27: Rehabilitation Facilities and Programs.

List of BIRP providers and locations

Contact Us

BIRP providers and locations as of January 2026

Washington

Convivio Health (NWRTW)
16201 25th Ave West
Lynnwood, WA 98087
425-774-9564 Email: info@cvvoh.com

Rehabilitation Institutes of Washington
415 1ST Ave N, STE 200
Seattle, WA 98109
206-859-5030 Email: info@rehabwashington.com

Oregon

Rehab Without Walls – Portland, Oregon
4640 S. Macadam Ave Suite 90
Portland, Oregon 97239
(503) 292-0765 Fax: (503) 292-5208

Brain Rehab Network
7204 SW Durham RD, STE 100
Portland, OR 97224
503-941-9869

California

Neurorestorative
7732 E Santiago Canyon Rd
Orange, CA 92869
714-771-5276

Illinois

Shirley Ryan AbilityLab
355 E Erie St.
Chicago, IL 60611

Texas

North Texas Rehabilitation Center
214 West Colorado Boulevard
Dallas, TX 75208

Other resources
  • TBI workbook – The Washington State Department of Social and Health Services (DSHS) has developed a workbook to help TBI survivors and their families TBI-Resources-and-Workbook-22-1913-Feb-2023.pdf (wa.gov)
  • TBI Capable Caregiver Book – The Washington State DSHS Aging and Long-Term Support Administration has published a book for caregivers and families on TBI and how to support patients with TBI 22-1828.pdf (wa.gov)
    • Its available in 13 languages
  • WA211 (wa211.org) is the provider for DSHS TBI Information and Referral Services providing information about services and assists in connecting patients with resources and services
    • Washington 2-1-1 is a free confidential service
    • Its accessed by CALL 2-1-1 or (877) 211-9274 or online Wa211.org
  • Washington State also hosts support groups for patients with a TBI Traumatic Brain Injury (TBI) Support | HeyPeers