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.

Archived Coverage Decisions.

See Treatment Guidelines and Resources for additional information.

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Catheter ablation is a procedure used to treat some types of heart arrhythmias, most commonly those tachyarrhythmias that originate above the ventricles. These SVTAs can be categorized by the origin of the tachyarrhythmia.

  • Atrial tachyarrhythmias initiate within the atrium:
    • sinus tachycardia,
    • atrial tachycardia,
    • macroreentrant atrial tachycardia (i.e., atrial flutter), and
    • atrial fibrillation.
  • Atrioventricular tachyarrhythmias originate within the atrioventricular (AV) node or the surrounding area:
    • AV nodal reentrant tachycardia,
    • AV reentrant tachycardia, which includes Wolf-Parkinson-White Syndrome,
    • focal junctional ectopic tachycardia, and
    • nonparoxysmal junctional tachycardia.

Catheter ablation is typically performed in a catheter lab and involves guided insertion of catheters from the arm, groin, or neck through the blood vessel and into the heart.

Conditions of Coverage

  • Injured workers must be adults with supraventricular tachyarrhythmias
  • Reentrant tachycardias (e.g. Wolff-Parkinson-White Syndrome [WPW]), Atrioventricular reentrant tachycardia (AVRT), Atrioventricular nodal reentrant tachycardia (AVNRT)
  • Atrial flutter:
    • Symptomatic atrial flutter
  • Atrial fibrillation:
    • Symptomatic atrial fibrillation
    • Drug therapy is either not tolerated or ineffective
  • The catheter ablation procedures are not covered benefits for other, non-reentrant supraventricular tachycardias.
Background information

The State Health Technology Clinical Committee (HTCC) reviewed catheter ablation procedures for SVTAs on May 17, 2013. The committee’s determination, based on a systematic review of the evidence of safety, efficacy and cost-effectiveness, is that catheter ablation procedures are covered benefits with conditions. Complete information on this HTCC determination is available here: What we're working on | Washington State Health Care Authority

Implementation of the Determination

Catheter ablation procedures for SVTAs may be used only for care of a condition accepted on the claim. Temporary authorization may be given to address an unrelated condition that is directly impeding worker’s recovery from their work-related condition. All requests require prior authorization.