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.

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Whole exome sequencing

Whole exome sequencing (WES) is a technology used to identify small changes in DNA sequences in exomes (the protein-coding regions), which disrupt protein function and cause diseases. The test is used to evaluate unexplained congenital or neurodevelopmental disorders.

The Health Technology Clinical Committee (HTCC) reviewed the technology recently and determined that WES is a covered benefit with conditions. However, L&I’s Office of the Medical Director has determined that this HTCC coverage determination does not apply to Washington’s workers’ compensation, which only covers work-related injuries or occupational disease.

Background Information

The HTCC reviewed WES and made a determination in 2019, which was finalized in May 2020. Complete information on this HTCC determination is available here: What we're working on | Washington State Health Care Authority.

Regulatory Authority and Related Information