Treatments requiring authorization

Below are treatments that require authorization.

• Office calls in excess of the first 20 visits or 60 days (whichever occurs first).
• Most inpatient hospital admissions.
• Outpatient surgeries:
• All treatments require claim manager authorization.
• Selected treatments require Utilization Review authorization. See Provider Bulletin 06-06 (151 KB PDF).
• Diagnostic studies other than routine x-ray and blood or urinalysis laboratory studies, x-ray therapy, radium therapy, myleogram and discogram in nonemergent cases.
• Physical therapy treatment beyond initial 12 treatments as outlined in:
  • WAC 296-21 - Reimbursement policies.
  • WAC 296-23 - Radiology, radiation therapy, nuclear medicine, pathology, hospital, chiropractic, physical therapy, drugless therapeutics, nursing, work hardening and more.
  • WAC 296-23A - Hospitals.
• Diagnostic or therapeutic injection. Epidural or caudal injection of substances other than anesthetic or contrast solution will be authorized under the following conditions only:
  • When the worker has experienced acute low back pain or acute exacerbation of chronic low back pain of no more than six months duration.
  • The worker will receive no more than three injections in an initial 30-day period, followed by a 30-day evaluation period. If significant pain relief is demonstrated one additional series of three injections will be authorized. No more than six injections will be authorized per acute episode.
  • See L&I's Drug Policy page for more information.
• Home nursing, attendant services or convalescent center care must be authorized per provisions outlined in WAC 296-20-091.
• Provision of prosthetics, orthotics, surgical appliances, special equipment for home or transportation vehicle, custom made shoes for ankle/foot injuries resulting in permanent deformity or malfunction of a foot, TNS units, masking-devices, hearing aids, etc., must be authorized in advance according to:
  • WAC 296-20-1101 - Hearing aids and masking devices.
  • WAC 296-20-1102 - Special equipment rental and purchase prosthetic and orthotics equipment.
• Referrals to mental health specialists.