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.
Electrical Stimulation for Chronic Wounds
L&I or self-insurer covers electrical stimulation for specific wound indications with prior authorization.
Electrical stimulation passes electric currents through a wound to accelerate wound healing via angiogenesis promotion, collagen synthesis and epithelial cell migration.
In this technique, one electrode is place on the skin near the wound and the other electrode is applied to saline-moistened guaze over the wound. As a conductive medium, saline allows the electric current to pass through the wound.
Four classes of devices are used and differentiated by type of current:
- Low-intensity direct current (LIDC).
- High voltage pulsed current (HVPC).
- Alternative current (AC).
- Transcutaneous electrical nerve stimulation (TENS).
- Stage III and IV pressure ulcers.
- Arterial ulcers.
- Diabetic ulcers.
- Venous stasis ulcers.
Prior authorization criteria
Prior authorization is required when electrical stimulation for chronic wounds is provided on an outpatient basis.
This technique will be authorized if the wound has not improved following 30 days of standard wound therapy. In addition to electrical stimulation, standard wound care must continue.
Criterion for continuing treatment beyond 30 days
A licensed medical personnel must provide documentation of wound measurements that show improvement has occurred within the past 30 days.