INTERPRETIVE OR POLICY STATEMENT
LABOR AND INDUSTRIES
If you have any questions or need additional information, please call Carmen Moore at (360) 902-4206.
POLICY AND INTERPRETIVE STATEMENTS
Insurance Services Division
Provider Bulletin 05-02 Coverage Decisions (October 2004 to December 2004)
This provider bulletin describes recent coverage decisions from the office of the medical director. The following coverage decisions are effective on March 1, 2005, and pertain to state fund and self-insured employers in all locations. The noncoverage decision on artificial discs is currently in effect and pertains to state fund claims and self-insured employers in all locations. Each treatment modality includes a brief description about it.
|•||Botulinum toxin - explains when these injections will be authorized or denied and provides the billing codes.|
|•||Electrical stimulation - explains when electrical stimulation is covered and what type of devices.|
|•||Hyperbaric oxygen therapy - explains when the therapy will be authorized and the billing codes.|
|•||Negative pressure wound therapy or wound vacuum assisted closure (VAC) - explains when the therapy will be authorized or denied and the billing codes.|
|•||Artificial discs and implantations for degenerative disc disease - explains these are noncovered devices because they are considered investigational and experimental. This portion of the provider bulletin replaces the artificial disc replacement for degenerative disc disease of the lumbar region coverage decision memo dated December 20, 2004.|
Contact Person: Gary Franklin MD, MPH, phone (360) 902-6500.
Provider Bulletin 05-04 Interpretive Services Payment Policy
This coverage and payment policy including new fees, codes, service descriptions, limits and provider qualification standards is effective on and after July 1, 2005.
This policy applies to interpretive services provided for healthcare and vocational services in all geographic locations to injured workers and crime victims (collectively referred to as "insured") having limited English proficiency or sensory impairments; and receiving benefits from the following insurers:
|•||The state fund (L&I),|
|•||Self-insured employers, or|
|•||The crime victim's compensation program.|
|•||Revised coverage and payment policy.|
|•||Interpretive services provider qualifications.|
|•||Revised interpretive services codes and descriptions.|
|•||New fees for interpretive services.|
|•||Limits on interpretive services.|
|•||Verification of interpretive services requirement.|
Contact Person: Karen Jost, phone (360) 902-6803.
Provider Bulletin 05-07 Durable Medical Equipment (DME) Coverage and Payment Policy
The provider bulletin pertains to claims made against both the state fund and self-insured employers (insurers) by injured workers and to the crime victim's compensation program. The bulletin describes the department's new durable medical equipment (DME) program. The new DME program changes the way that the department pays for both purchased and rented DME. Effective July 1, 2005, DME will be paid per a maximum fee schedule. Codes and fees schedules will be posted by June 1, 2005. This provider bulletin was issued May 2005.
Contact Person: John Elshaw, phone (360) 902-5131.
Provider Bulletin 05-08 Chiropractic Consultant Program
This bulletin replaces provider bulletin 03-06 "Chiropractic Consultation Program." The bulletin applies to both state fund and self-insured claims. The bulletin is in effect for dates of service on or after June 1, 2005. The provider bulletin describes the department's policies on consultation referrals for the chiropractic consultation program (second opinion consultations) and department rating examinations. This provider bulletin was issued June 2005.
Contact Person: Joanne McDaniel, phone (360) 902-6817.
Policy Bulletin 05-10 Antiepileptic Drugs Guideline for Chronic Pain
The purpose of this guideline is to provide guidance to treating physicians in the use of antiepileptic drugs (AEDs) in the management of neuropathic pain. This provider bulletin was issued August 2005.
Contact Person: Jaymie Mai, phone (360) 902-6792.
Provider Bulletin 05-11 Guideline on Diagnostic Facet Medial Nerve Branch Blocks and Facet Neurotomy
The purpose of this provider bulletin is to clarify the department's payment policy on the number of joint levels for diagnostic medial nerve branch blocks and facet neurotomies that may be performed on the same day. The medical treatment guideline in this provider bulletin also contains information on the diagnosis and treatment criteria for cervical or lumbar facet joint pain. This provider bulletin was issued August 2005.
Contact Person: LaVonda McCandless, phone (360) 902-6163.
Governmental Affairs Office