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.

See Treatment Guidelines and Resources for additional information.

Structured intensive multidisciplinary programs (SIMPs) are outpatient programs that deliver regularly scheduled, daily, interdisciplinary care for the treatment of chronic pain. The programs consist of six- to eight-hour days, 5 days per week for two to four weeks duration. The medical services provided in a SIMP are coordinated, goal-directed, and team-based.

SIMPs help workers with chronic pain so they can:

  • Recover function,
  • Reduce or eliminate disability and
  • Improve the quality of their lives.

Conditions of Coverage

SIMP services require referral from the AP and prior authorization from the claim manager. A SIMP evaluation may be authorized if the worker:

  • Has had unresolved chronic pain (i.e. pain lasting more than 3 months) despite conservative care, and
  • Has one or more of the following conditions:
    • Is unable to return to work due to the chronic pain, or
    • Has returned to work but needs help with chronic pain management, or
    • Has significant pain medication dependence, tolerance, abuse, or addiction

Other Resources

SIMP review (April 2021)

For more information on SIMPs, see MARFS Chapter 34: Chronic Pain Management