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.
Treatment of chronic migraine or chronic tension-type headache with the following modalities is not a covered benefit:
- Manipulation/manual therapy
- Transcranial magnetic stimulation
- Trigger point injections
OnabotulinumtoxinA* is not a covered benefit for the treatment of chronic tension-type headache.
* Please note that OnabotulinumtoxinA for the treatment of chronic migraine is a covered benefit with conditions. For coverage criteria, please see “Botulinum toxins”.
Treatment of chronic migraine and chronic tension-type headache was reviewed by the State Health Technology Clinical Committee (HTCC) in May 2017 and the determination was finalized on July 14, 2017. Complete information on this HTCC determination is available at: 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 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).