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.
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.
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.