Washington State Approves Spinal Cord Stimulation for Certain Pain Conditions
On June 14, 2024, there was a final adoption of new guidelines for spinal cord stimulation (SCS). Spinal cord stimulation is a treatment for chronic pain involving the insertion of electrodes into the epidural space near the spinal cord that are connected to an internal or external electrical pulse generator.
Previously, as of September 29, 2008, SCS was not a treatment covered under the Labor and Industries guidelines, with automatic disapproval for SCS. In 2022, SCS was selected to be reviewed to assess whether there could be change in the original coverage determination. The Health Technology Clinic Committee of Washington met on May 17, 2024 and made a new coverage determination: SCS is a covered benefit with conditions for failed back surgery syndrome, non-surgical refractory back pain and painful diabetic neuropathy. An additional determination was made that outlines SCS is not covered for treatment of Complex Regional Pain Syndrome (CRPS.)
However, it is important to note, coverage for SCS does not provide blanket coverage for the above conditions. For example, for the condition of failed back surgery syndrome, a few of the limitations include:
- If a worker is less than 12 months post-surgery, they are not a candidate for SCS
- They must have persistent low-back and neuropathic leg pain
- There must be a moderate to severe [≥5 on the visual analog (VAS) or numeric rating (NRS) pain scales] neuropathic pain and objective neurologic impairment with documented pathology related to pain symptoms (i.e., abnormal MRI). Neurologic impairment is defined as objective evidence of one or more of the following: 1) Markedly abnormal reflexes 2) segmental muscle weakness 3) segmental sensory loss, or 4) Electromyography (EMG) or nerve conduction study (NCS) evidence of nerve root impingement
- Functional disability assessed using the Oswestry Disability Index (ODI); ODI score ≥21%.
Additional coverage information and overview of limitations can be reviewed here.
There are other relevant factors to consider under when making a determination to authorize or deny treatment and coverage is excluded when any of the following are present:
- Life expectancy less than one (1) year
- Hemoglobin A1C (HbA1C) >10 (for PDN)
- Body mass index (BMI) >45
- Maximum daily morphine milligram equivalent (MME) ≥120
- Concurrent, untreated, substance use disorder (including alcohol, prescription or illicit drugs) per American Society of Addiction Medicine (ASAM) guidelines
- Active, substantial chronic pain in other regions that have required treatment in the past year
- Related or pending worker’s compensation claim (for failed surgery back syndrome) and non-surgical refractory back pain
- Pending or existing litigation for the condition being treated with SCS
It is pertinent to carefully consider whether a worker is an appropriate candidate for SCS under the updated guidelines. If you have any questions regarding the new rules relating to SCS, please contact me at or 503-595-6106.
Posted by Allison Harper.
