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.

Discography is a radiologic diagnostic procedure for the evaluation of spinal conditions in which contrast material is injected into the nucleus pulposus of the lumbar disc.

Coverage decision

Discography in the assessment of chronic low back pain or lumbar degenerative disc disease is not covered.

Discography requires prior authorization for patients with any other condition(s) including the following:

• Radiculopathy
• Functional neurologic deficits (motor weakness or EMG findings of radiculopathy)
• Spondylolisthesis (>Grade 1)
• Isthmic spondylolysis
• Primary neurogenic claudication associated with stenosis
• Fracture, tumor, infection, inflammatory disease
• Degenerative disease associated with significant spinal deformity

Information on how to request authorization review is included below.

Background Policy Information

The State Health Technology Clinical Committee (HTCC) reviewed discography on February 15, 2008. The committee’s determination, based on a systematic review of the evidence of safety, efficacy and cost-effectiveness, is that discography is not covered for patients with chronic low back pain or lumbar degenerative disc disease.

Complete information on this HTCC determination is available here: What we're working on | Washington State Health Care Authority

Implementation of this Determination

Beginning June 15, 2008 all requests for discography require prior authorization and will be reviewed by L&I’s utilization review (UR) vendor (Comagine) for State Fund or a nurse consultant for the Crime Victims Compensation Program.