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.

Occupational Health Best Practices and L&I header

The following noninvasive cardiac imaging technologies for coronary artery disease are covered with conditions:

  • Stress echocardiography
  • Single Photon Emission Tomography (SPECT)
  • Positron Emission Tomography (PET)
  • Coronary Computed Tomographic Angiography (CCTA)
  • CCTA with Fractional Flow Reserve (FFR)

Conditions of coverage

  • Stress echocardiography for:
    • Symptomatic adult patients (≥18 years of age) at intermediate or high risk of Coronary Artery Disease (CAD), or
    • Adult patients with known CAD who have new or worsening symptoms.
  • Single Photon Emission Tomography (SPECT) for:
    • Patients under the same conditions as stress echocardiography when stress echocardiography is not technically feasible or clinically appropriate.
  • Positron Emission Tomography (PET) for:
    • Patients under the same conditions as SPECT, when SPECT is not technically feasible or clinically appropriate.
  • Coronary Computed Tomographic Angiography (CCTA) for:
    • Symptomatic adult patients (≥18 years of age) at intermediate or high risk of CAD, or
    • Adult patients with known CAD who have new or worsening symptoms.
  • CCTA with Fractional Flow Reserve (FFR) for:
    • Patients under the same conditions as CCTA, when further investigation of functional significance of stenosis is clinically indicated

Notes:

  • Out of scope/data not reviewed for this decision:
    • Asymptomatic individuals, follow up of prior abnormal cardiac imaging studies, myocardial viability, preoperative evaluation
    • Patients presenting for evaluation of cardiac pathologies other than CAD


Background Information

The State Health Technology Clinical Committee (HTCC) initially reviewed CCTA in 2008, and SPECT/PET in 2013, respectively. The committee reviewed the new evidence of SPECT, PET and CCTA in November 2021 and voted again to cover these noninvasive cardiac imaging technologies with conditions. In addition, the committee reviewed two other technologies, stress echocardiography and CCTA with FFR. The committee’s determination, based on a systematic review of the evidence of safety, efficacy and cost-effectiveness, is that these noninvasive cardiac imaging technologies for coronary artery disease are covered benefits with conditions. Complete information on this HTCC determination is available here: What we're working on | Washington State Health Care Authority. This determination supersedes the following previous HTCC determinations:

  • Coronary Computed Tomographic Angiography for detection of Coronary Artery Disease (20081114A)
  • Cardiac Nuclear Imaging (20130920A)

In adopting this HTCC coverage determination, the Department has concluded that the determination does not conflict with any state statute. Any coverage for investigational treatment would be considered per WAC 296-20-02850. Any coverage for health technologies that have a FDA Humanitarian Device Exemption status would be considered per RCW 70.14.120 (1) (b).