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.
L&I’s Office of the Medical Director has determined that the HTCC’s decision to cover bariatric treatment for obesity does not apply to Washington’s workers’ compensation because generally, obesity does not meet the definition of an industrial injury or occupational disease. Temporary non-invasive treatment may be allowed when the condition of obesity hinders the recovery from an accepted condition and when specific criteria are met. Please refer to L&I Billing and Payment Policies for the criteria.
The State Health Technology Clinical Committee (HTCC) reviewed bariatric surgery for treating obesity in May 2015. The committee’s determination, based on a systematic review of the evidence of safety, efficacy and cost-effectiveness, is that bariatric surgery for patients aged 18 and older is a covered benefit with conditions. Complete information on this HTCC determination is available here: What we're working on | Washington State Health Care Authority.