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.

How to use the guidelines

Although doctors are expected to be familiar with the guidelines and follow the recommendations, L&I also understands that guidelines are not hard-and-fast rules. 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) (112 KB PDF). (Effective August 1, 2009)
• Ankle/Foot Surgery (31 KB PDF).
• Antiepileptic drugs guideline for chronic pain (22 KB PDF).
• Carpal Tunnel Syndrome (CTS) Guideline(267 KB PDF). (Effective April 1, 2009)
• Cervical Nerve Root, Single (28 KB PDF).
• Complex Regional Pain Syndrome (CRPS-2011) (373 KB PDF). (Effective October 1, 2011)
• Controlled Substances (61 KB PDF).
• Facet Neurotomy (73 KB PDF).
• Knee Surgery (73 KB PDF).
• Low Back Pain, Guideline for Hospitalization for (40 KB PDF).
• Lumbar Fusion, Guidelines for (Arthrodesis) (36 KB PDF). (Effective November 1, 2009)
• Lumbar Nerve Root, Single (Lumbar Laminectomy) (20 KB PDF).
• Outpatient Prescription of Oral Opioids for Chronic, Noncancer Pain (193 KB PDF).
• Porphyria (30 KB PDF).
• Proximal Median Nerve Entrapment (PMNE) (150 KB PDF).(Effective August 1, 2009)
• Psychiatric Conditions (53 KB PDF).
• Radial Nerve Entrapment: Diagnosis and Treatment (152 KB PDF). (Effective April 1, 2010)
• Shoulder Surgery, Criteria for (49 KB PDF).
• Thoracic Outlet Syndrome - Neurogenic (204 KB PDF). (Effective October 1, 2010)
• Thoracic Outlet Syndrome - Vascular (26 KB PDF).
• Ulnar Neuropathy at the Elbow (UNE) Diagnosis and Treatment (167 KB PDF). (Effective January 1, 2010)

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For questions about these guidelines or the guideline development process, please contact:

Simone P. Javaher, ONC
Email: Simone.Javaher@Lni.wa.gov
Phone: 360-902-5762.

Archived Medical Treatment Guidelines

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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

• Lower extremity checklist (48 KB PDF).
• Upper extremity checklist (42 KB PDF).
• Lumbar spine checklist (46 KB PDF).
• Headache checklist (20 KB PDF).
• Cervical spine checklist (21 KB PDF).
• Thoracic spine checklist (36 KB PDF).