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.

Archived Coverage Decisions.

See Treatment Guidelines and Resources for additional information.

Reviewed and updated:  May 1, 2025

Vertebroplasty, kyphoplasty and sacroplasty are surgical interventions used to treat fractures of the bones in the spine (vertebrae). These treatments are not covered for State Fund and Self-Insured workers’ compensation claims.

On December 10, 2010, the State Health Technology Clinical Committee (HTCC) met to determine if the scientific evidence supports coverage of these treatments by state agencies. Based on a review of the best available evidence of the safety, effectiveness and value, the HTCC determined that vertebroplasty, kyphoplasty and sacroplasty are not covered for any condition. The decision was made final in March 2011. Recently, the HTCC reviewed the most current evidence and determined once again that vertebroplasty, kyphoplasty and sacroplasty are not covered benefits. The coverage determination was finalized in March 2025. Complete information on this HTCC determination is available here: Health technology reviews | 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).

Regulatory authority and related information

• RCW 70.14.080 through 70.14.130
• Health Technology Assessment Program
• WAC 296-20-02700 through 296-20-02850