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.

UPDATED AND EFFECTIVE:  02/01/2026

Coverage decision: Covered with conditions

To receive the benefit, injured workers must have the primary condition that is accepted on the claim or a condition hindering recovery that includes at least one of the following conditions:

• Crush injuries and suturing of severed limbs; as an adjunct when loss of function, limb, or life is threatened.
• Compromised skin grafts and flaps (not for primary management of wounds)
  Chronic refractory osteomyelitis unresponsive to conventional medical and surgical management.
• Osteoradionecrosis; as an adjunct to conventional treatment.
• Treatment for prevention of osteoradionecrosis associated with tooth extraction in a radiated field.
• Soft tissue radionecrosis; as an adjunct to conventional treatment.
• Diabetic wounds in patients who meet the following three criteria:
  • Patient has type I or type II diabetes and has a lower extremity wound that is due to diabetes;
  • Patient has a wound classified as Wagner grade III or higher; and
  • Patient has failed an adequate course of standard wound therapy.
• Sudden hearing loss due to acute acoustic trauma (AAT):
  • Patients with:
    • Moderate to severe hearing loss, AND
    • Treatment must start within 30 days of onset.

Note: In AAT, exposure to a short-impact, acoustic impulse with an intensity of 90 to 130 dB for a duration of 1 millisecond or longer causes the cochlea to become mechanically damaged with resulting microcirculation vasospasm and hypoxia to the cochlear sensory cells. Symptoms include high-frequency sensorineural hearing loss (4,000 Hz and higher) and tinnitus. The types of occupational AAT would normally be related to such things as mine blasting, gunshots in law enforcement, and the like.

HBOT is not covered for the following conditions:

• Brain injury including traumatic (TBI) and chronic brain injury
• Cerebral Palsy
• Multiple Sclerosis
• Migraine or cluster headaches
• Acute and chronic sensorineural hearing loss
• Thermal burns
• Non-healing venous, arterial and pressure ulcers

Note: Sudden sensorineural hearing loss (SSNHL) is the rapid loss of hearing with onset over a period of less than 72 hours. It involves a decrease in hearing of ≥ 30 decibels (dB) affecting at least 3 consecutive frequencies. More than 90% of SSNHL cases are idiopathic. Idiopathic SSNHL is typically not work-related, therefore HBOT for idiopathic SSNHL is usually not covered by the Department. Any request of coverage for this condition is subject to medical review.

Criterion for Continuing Treatment beyond 30 sessions:

In order for payment for HBOT to continue beyond 30 sessions, licensed medical personnel must provide documentation of wound measurements that demonstrate clinically meaningful improvement that has occurred with the first 30 sessions. The maximum treatment sessions allowed are 60.

Note: The insurer typically pays for HBOT for the following conditions resulting from a work-related incident: air or gas embolism, carbon monoxide poisoning and decompression sickness.

Background Policy Information

The State Health Technology Clinical Committee (HTCC) reviewed HBOT firstly in 2013. The committee reviewed HBOT for sensorineural hearing loss and acute acoustic trauma in March 2025. The committee’s determinations, based on systematic reviews of the evidence of safety, efficacy and cost-effectiveness, are that HBOT is a covered benefit with conditions. Complete information on these HTCC determinations is available here:
Health Technology Reviews | Washington State Health Care Authority