Washington L&I Expands Coverage for Acupuncture Treatment
The Washington Department of Labor & Industries recently adopted a new policy approving acupuncture as a covered treatment for chronic migraine when accepted under a workers compensation claim.
Previously, acupuncture was a covered benefit only for treatment of accepted lumbar conditions. The Department adopted its lumbar coverage policy for acupuncture in 2019.
Although acupuncture is now covered for treatment of accepted migraine and lumbar conditions, there are important distinctions between the policies. When acupuncture is used to treat an accepted lumbar condition, no pre-authorization is required. There must only be documentation of a referral from the attending provider in the claim file. The policy also limits coverage to no more than ten medically necessary treatments over the lifetime of a claim.
Notably, the Department’s policy for coverage of acupuncture for chronic migraine requires pre-authorization for treatment, as well as a referral from the attending provider. However, the policy also allows for much more extensive treatment for chronic migraine than for lumbar conditions – up to to 24 sessions over the course of one year. The policy further indicates that up to 24 more sessions may be authorized, but only if additional criteria are met. These criteria include a showing of significant improvement in symptoms on a validated scale for chronic migraine with the initial treatment cycle. The policy indicates that a change of ≥ 4.5 points in the Migraine Disability Assessment Score [MIDAS] or a decrease of ≥6 points in the Headache Impact Test [HIT-6] Total Scores) would qualify as “significant” improvement.
As the Department expands its coverage for alternative treatments like acupuncture, it’s important to understand what conditions are covered and what limitations apply to coverage. If you have any questions regarding the new Washington acupuncture policies or other coverage issues, please contact me at or 503-595-6113.
Posted by Kara Cogswell Kidder.
