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.
Spinal cord stimulation is a treatment for chronic pain involving the insertion of electrodes into the epidural space near the spinal cord that are connected to an internal or external electrical pulse generator.
Spinal Cord Stimulation (SCS) is a non-covered procedure for workers’ compensation claims (both State Fund and Self-Insured) and for Crime Victims’ claims.
For injured workers treated with SCS during the University of Washington SCS Study (completed in 2008), future treatment coverage for currently implanted spinal cord stimulators will be reviewed on a case-by-case basis considering medical necessity, improvement in pain and function, adverse effects and the rationale for continuing treatment.
Spinal cord stimulation (SCS) involves the insertion of electrodes, into the epidural space near the spinal cord. The electrodes are connected to an internal (implanted) or external electrical pulse generator. SCS is proposed to treat specific chronic pain by inhibiting the conduction of pain signals to the brain. SCS has been used to treat chronic low back and leg pain that has failed to respond to spine surgery and complex regional pain syndrome (CRPS) when other treatments have failed.
L&I Sponsored SCS Pilot Study
SCS has been a non-covered procedure for all conditions since prior to 2004. In 2004, L&I sponsored a study (SCS Study) to evaluate the effectiveness of SCS for injured workers with chronic low back and leg pain after lumbar surgery. The study design and criteria were published in Provider Bulletin 05-03 in 2005.
The Final Report from the SCS Study, conducted by researchers at the University of Washington, was completed September 30, 2008. The SCS Study authors found:
- Little evidence supporting superiority of SCS over alternative treatments
- Small advantage of SCS in improving leg pain and function at 6 months
- No advantage of SCS in improving leg pain, function, or any other measure at 12 or 24 months
- Adverse events with both trial and permanent SCS including infections and persistent pain in the region of the implanted components
- 19% of patients in the study who received a permanent SCS had it removed within 18 months
- 19% required revision surgery within 18 months
- Costs (medical and productivity) were higher in the SCS group than in the comparison groups (pain clinic treatment and usual care)
The complete SCS Study Final Report is available here. (link)
Health Technology Assessment Program Review
On August 20, 2010, the State Health Technology Clinical Committee (HTCC) met at an open public meeting to determine whether state agencies should pay for SCS for treatment of neuropathic pain. Based on a review of the best available evidence of safety, efficacy and cost-effectiveness, the committee’s determination is that SCS is not covered for treatment for this condition. The decision was made final by the HTCC on October 22, 2010.
Complete information on this HTCC determination is available at:
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