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 determination about continuous glucose monitoring (CGM) does not apply to Washington’s workers’ compensation because diabetes is not typically work related, and therefore does not meet the definition of an industrial injury or occupational disease.
In rare situations, L&I may pay for CGM based on the criteria set forth in the 2018 HTCC’s determination on CGM if diabetes is an accepted condition on the claim. It must be documented in the claim file that the industrial injury giving rise to the claim was a proximate cause of the diabetic condition or how diabetes is related to the claim.
Continuous glucose monitoring was re-reviewed by the State Health Technology Clinical Committee (HTCC) in January 2018 and the determination was finalized in March 2018. Complete information on this HTCC determination is available at: What we're working on | Washington State Health Care Authority.