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 chondrocyte implantation (ACI) is not a covered procedure for Washington States’ injured workers, effective on August 1, 2016. For further information, please refer to Surgical Guideline for Work-related Knee Injuries.
ACI is a two-stage technique done to treat localized cartilage defects in the femoral condyle, trochlea, or patella. The first stage is the harvesting and culturing of cartilage cellsIn the second stage, these cells are implanted into the area of cartilage defect, with the goal of stimulating generation of cartilage in hopes of preventing or slowing the onset of osteoarthritis. However, current scientific evidence shows that ACI is inferior to other procedures such as osteochondral autograft/allograft transplantation (OAT) and marrow stimulation procedures (e.g. microfracture, subchondral drilling, or abrasion arthroplasty) in terms of effectiveness and success rate.