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: 02/01/2022

Coverage decision: Covered with conditions.

Electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS)* are covered benefits for workers with a unipolar or bipolar diagnosis (excluding adjustment disorder) 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

• Electroconvulsive therapy and repetitive transcranial magnetic stimulation may be used only for care of a condition accepted on the claim. All requests require prior authorization.
• *The Department does not cover rTMS for the treatment of treatment-resistant depression using an experimental protocol, such as the Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT).

Background Policy Information

The State Health Technology Clinical Committee (HTCC) reviewed nonpharmacologic 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 are covered benefit. Complete information on this HTCC determination is available here: What we're working on | Washington State Health Care Authority.

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.

Since the initial coverage decision in 2014, researchers have been testing rTMS using experimental protocols. Although the preliminary results were encouraging, long-term outcomes of safety and efficacy are unproven. The Department determined that rTMS treatment for treatment-resistant depression using an experimental protocol is not a covered benefit.