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.

Autologous blood injections (ABI) and platelet-rich plasma (PRP) injections are treatments utilized for a variety of healing applications, including refractory acute or chronic ligament injuries, muscle strain injuries, cartilage injuries, osteoarthritis, and tendinopathies. Despite the hypothesis that ABI and PRP injections may promote tissue healing due to increased concentration of growth-factors around the injured area, the efficacy and safety for ABI and PRP injection treatments are not well established.

Coverage decision: Not covered

Autologous blood/platelet-rich plasma injections are not a covered benefit. The decision is based on a Health Technology Clinical Committee (HTCC) coverage determination that was first reviewed in May 2016 and finalized on July 8, 2016. The committee's determination was based on a systematic review of the evidence for safety, efficacy and cost-effectiveness. Complete information on this HTCC determination is available here: What we're working on | Washington State Health Care Authority

In adopting this HTCC coverage determination, the Department has concluded that the determination does not conflict with any state statute. Any coverage for investigational treatment would be considered per WAC 296-20-02850. Any coverage for health technologies that have a FDA Humanitarian Device Exemption status would be considered per RCW 70.14.120 (1) (b).