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.

Stem cell therapy for musculoskeletal conditions

Coverage decision: Not Covered (Effective date: September 1, 2020)

Stem cell therapy is the use of pluripotent or multipotent stem cells to treat a disease or condition. Non-hematopoietic stem cells from tissues and organs (e.g., bone marrow and adipose tissue), collectively referred to as “mesenchymal stem cells”, are most frequently used as sources for musculoskeletal applications. While there have been a large number of pre-clinical studies related to musculoskeletal applications of stem cell therapy, such therapy is still in the relatively early stages of development. The evidence of effectiveness and safety from methodologically rigorous clinical studies is sparse and its value or safety has not been established.

The decision is based on the recent Health Technology Clinical Committee (HTCC) coverage determination finalized in July 2020. The committee reviewed the evidence and voted to not cover stem cell therapy for musculoskeletal conditions. 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 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).