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.
Effective Date: 10/01/2014; Last updated: 10/01/2023
Electroconvulsive therapy (ECT) is a covered benefit for injured workers with treatment-resistant depression if the following criteria are met:
- The worker failed two trials of different classes of anti-depressant drugs at maximum tolerated dose for 4-12 weeks; AND
- The worker complied with the prescribed treatment sufficiently for the provider to determine the trials failed; OR
- The trials failed because of early termination due to adverse events or reactions.
The following treatments are NOT covered:
- transcranial Direct Current Stimulation (tDCS)
- Deep Brain Stimulation (DBS)
Labor & Industries’ Implementation of the Determination
ECT may be used only for care of a condition accepted on the claim. All requests require prior authorization.
Background Policy Information
The State Health Technology Clinical Committee (HTCC) reviewed non-pharmacologic treatments for treatment-resistant depression on March 21, 2014. The committee’s determination, based on a systematic review of the evidence of safety, efficacy and cost-effectiveness, is that only certain treatments, including electroconvulsive therapy and transcranial magnetic stimulation (TMS), were covered benefits. The coverage decision was updated in October 2023, which entailed removal of the contents related to TMS since the HTCC reviewed new evidence and made a new coverage determination on TMS. The Department has adopted the determination. The new coverage decision on TMS supersedes the TMS portion of this coverage decision.
In adopting this HTCC coverage determination, the Department has concluded that the determination does not conflict with any state statute. Any coverage for humanitarian or investigational treatment would be considered per WAC 296-20-02850.