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.
CMRA is a covered benefit for adults or children with known or suspected coronary vessel anomalies or congenital heart disease.
CMRA is a covered benefit with conditions for stable symptomatic adults with known or suspected coronary artery disease (CAD).
Conditions of coverage
CMRA should not be a first line diagnostic tool in patients with stable symptoms consistent with coronary artery disease (CAD). CMRA is covered with conditions for stable symptomatic adults with known or suspected CAD when the following conditions are met:
- In consultation with a cardiologist, and
- The patient is unable to tolerate or safely participate in other noninvasive anatomic or functional testing.
CMRA is not a covered service in coronary artery bypass graft (CABG) patients without CAD symptoms, or in those requiring cardiac lead placement unless cardiac vascular anomalies are suspected.
- Out of scope/data not reviewed for this decision:
- Cardiac stress MRI
The State Health Technology Clinical Committee (HTCC) reviewed the evidence of CMRA and voted to cover the technology in November 2021. The committee’s determination, based on a systematic review of the evidence of safety, efficacy and cost-effectiveness, is that CMRA 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.
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).