The medical treatment guidelines are written from a clinical perspective, to guide clinical care. Providers should consult the Medical Aid Rules and Fee Schedule (MARFS) for documentation and coding requirements.
The Medical Treatment Guidelines (also called Medical Practice Guidelines or Review Criteria) are evidence based and were developed by the Office of the Medical Director in collaboration with practicing physicians and advisors.
Some guidelines are intended to be educational tools for medical providers. Some guidelines and the review criteria are used by L&I in the Utilization Review program and claim management process to promote best practices and improve the health of injured workers. They are published by L&I, which is solely responsible for coverage decisions that may result from their use.
See Conditions and Treatments (Coverage Decisions) for additional information.
How to use the guidelines
Health care providers are expected to be familiar with the guidelines and follow the recommendations. Good medical judgment is important in deciding how to use and interpret this information.
Guideline history and development process
See the Guideline Process for background information and a description of how guidelines are prioritized, developed, and implemented. All current guidelines are those listed individually below.
Medical Treatment Guidelines
- Acute Cauda Equina Syndrome (CES)
- Ankle and Foot Surgical Guideline
- Beryllium - Clinical Guideline for the Diagnosis of Beryllium Sensitization and Chronic Beryllium Disease.
- Carpal Tunnel Syndrome (CTS) Guideline
- Cervical Radiculopathy and Myelopathy
- Complex Regional Pain Syndrome (CRPS-2011)
- Facet Neurotomy
- Knee Surgery (CME)
- Low Back Pain, Guideline for Hospitalization for
- Lumbar Fusion Guideline (arthrodesis)
- Lumbar Nerve Root, Single (Lumbar Radiculopathy)
- Porphyria Conditions
- Prescribing Opioids to Treat Pain in Injured Workers
- Proximal Median Nerve Entrapment (PMNE)
- Radial Nerve Entrapment: Diagnosis and Treatment
- Sacroiliac - Interim Decision
- Shoulder Conditions Diagnosis and Treatment Guideline
- Single Cervical Nerve Root
- Spinal Injections
- Thoracic Outlet Syndrome - Neurogenic
- Thoracic Outlet Syndrome - Vascular
- Ulnar Neuropathy at the Elbow (UNE) Diagnosis and Treatment
Advanced Imaging Guidelines
The Washington Legislature passed a new law in 2009 (ESHB 2105/ Chapter 258, Laws of 2009) that directed the State to convene an Advanced Imaging Management Work Group. The Work Group was directed to identify evidence-based best practice guidelines for advanced imaging; State agencies were directed to implement the Work Group recommendations. Work Group recommendations include:
- Evidence-based checklists for certain high-cost, high-use imaging studies.
- Web-based utilization review.
For information about how to request authorization please see L&I's utilization review information pages.
Guidelines for Advanced Imaging Studies
Practice Resources for Attending Providers
L&I offers up to 3 hours of online continuing education credit for successfully completing each quiz associated with a resource.
Industrial Insurance Chiropractic Advisory Committee Occupational health practice resources - with CE available
These conservative care resources target specific occupational conditions/regions. The best evidence has been collected and organized to provide you with easy strategies to manage these conditions. Recommendations for provocation tests, diagnostic strategies, outcomes assessments and treatment interventions are included.
- 2019 Reducing Disability: Psychosocial Determinants Influencing Recovery - Quiz (3 CME)
- 2018 Options for Documenting Functional Improvement in Conservative Care plus Functional Scales - Quiz (3 CE)
- 2018 Conservative Care of Occupational Knee Conditions - Quiz (3 CME)
- 2017 Active Rehabilitation for Work-Related Low Back Conditions - Quiz (3 CME)
- 2015 Conservative Care Options for Work-Related Foot and Ankle Conditions - Quiz (3 CE)
- 2014 Conservative Care Options for Occupational Carpal Tunnel Syndrome - Quiz (3 CE)
- 2014 Conservative Care Options for Work-Related Epicondylosis - Quiz (3 CE)
- 2014 Conservative Care Options for Work-Related Mechanical Shoulder Conditions - Quiz (3 CE)
Optimizing your practice
These resources can decrease the administrative burden and enhance your clinic’s ability to work within the Workers’ Compensation system. They include:
- Resources for proper documentation
- Reference materials for attending providers
- Services offered by L&I for injured workers
- Templates and forms for working with employers
- Forms for referral and collaboration
- Checklist tool for assessing your readiness for workers' comp patients
Treating injured workers
- 2016 Documentation Best Practices for Washington State Workers’ Compensation - Quiz (3 CE)
- Information about Office of Ombuds for Self Insured Injured Workers
- Handout - Help for Injured Workers of Self-Insured Employers (F207-213-000)
- Information about L&I Centers for Occupational Health and Education (COHE)
- Information and resources for providers about the Stay at Work program
- Information on activity coaching (F280-062-000)(Progressive Goal Attainment Program – PGAP)
Working with employers of injured workers
- 2015 Notice to Employer of Injured Worker Assessment & Treatment
- This template can be used to notify employers that your are attending one of their employees for an industrial injury. It lets you document important information and request the employer's assistance with return to work. It also includes useful information for the employer on what to do when they have a claim.
- 2015 Employer Contact Resource for AP's Office
- This workflow table identifies what your office staff and you need to do and document when you have a patient with a new work injury.
- 2012 Attending Providers Return To Work Desk Reference (F200-002-000)
- Return To Work Assistance For Employers
- Information and assistance with self-insured employers
- Includes lists of self-insured employers and their third party administrators.
Collaborating with other providers
- 2020 Attending Providers' Referral Practices Quick Reference Card - Quiz (3 CE)
- 2015 Attending Providers Referral Form (F252-098-000)
- 2013 PT/OT Referral Form (F252-099-000)
- Readiness Assessment Index for Occupational Health Best Practices – A tool to help you assess your clinic’s preparedness and policies around treating injured workers. Forms, tools, resources and a check-list for front office, back office and providers.
Upcoming continuing education seminars
Information on upcoming seminars can be found here.