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.
Last reviewed and updated: September 1, 2020
Vagal nerve stimulation (VNS) for treatment of depression is not covered.
Transcutaneous vagal nerve stimulation (tVNS) for treatment of epilepsy or depression is not covered.
Vagal nerve stimulation (VNS) for treatment of epilepsy is a covered benefit with conditions.
Conditions of coverage
Vagal nerve stimulation (VNS) for treatment of epilepsy is covered for adults and children (age 4 and older) when all of the following conditions are met:
- Seizure disorder is refractory to medical treatment, defined as adequate trials of at least 3 appropriate but different anti-epileptic medications.
- Surgical treatment is not recommended or has failed.
VNS may be used only for care of a condition accepted on the claim. Epilepsy is unlikely to be related to any occupational injury or disease and is therefore not expected to be an accepted condition on an L&I claim.
Vagal nerve stimulation (VNS) is a neuromodulatory therapy that sends electric signals to specific brain structures via known pathways and systems. A small device, called a pulse generator, is implanted into the left side of the chest to produce repeating, low-level pulses of electrical current that are transmitted via electrical leads along the vagus nerve and ultimately to the brainstem. VNS can be a treatment option for adults and children with epilepsy. VNS has also been used for the treatment of depression. Transcutaneous vagal nerve stimulation (tVNS) is a noninvasive alternative to the implanted VNS for some conditions. tVNS targets the cutaneous receptive field of the auricular branch of the vagus nerve at the outer ear.
The State Health Technology Clinical Committee (HTCC) reviewed VNS and made a determination (covered with conditions) in 2009. The committee reviewed the new evidence in May 2020 and voted again to cover VNS with conditions for epilepsy, and to not cover VNS for depression. In addition, the committee voted not to cover tVNS. 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).