Category Archives: Coverage Decision

Coverage Decision

WA State DLI Ends Coverage of Therapeutic Genicular Nerve Blocks for Knee Pain

The Washington State Department of Labor & Industries made a coverage decision on therapeutic genicular nerve blocks recently.  Genicular nerve block for treating chronic knee pain is not a covered benefit, effective October 1, 2018. 

The knee joint is innervated by the articular branches of several nerves including the femoral, common peroneal, saphenous, tibial and obturator nerves. These articular branches around the knee joint are known as genicular nerves.

Per the Department of Labor and Industries, genicular nerve block for treating chronic knee pain is controversial. The effectiveness of the procedure on relieving chronic knee pain is not established. The safety of repetitive anesthetic/steroid injections to the genicular nerves is unproven. 

The white paper produced to outline the basis for this decision includes reference to the practice guideline published by The American Society of Anesthesiologists, “Practice Guidelines for Chronic Pain Management” in 2010 []. It pulls the quote from the document “peripheral somatic nerve blocks should not be used for long-term treatment of chronic pain”.  The paper’s conclusion statement is: “The evidence regarding genicular nerve block is scant. Though some evidence showed that GNB might provide short-term pain relief, the effectiveness of this procedure on chronic knee pain has not been established. The safety and effectiveness of repetitive anesthetic/steroid injections are unproven.”

Genicular nerve block (GNB) may be performed for diagnosis or perioperative care. GNB for treating chronic knee pain is not covered.

Coverage Decision

WA State DLI New Coverage Decision – Surgery for Lumbar Radiculopathy/Sciatica

The Washington State Department of Labor & Industries has adopted a new Health Technology Clinical Committee coverage determination about surgery for lumbar radiculopathy/sciatica, effective November 1, 2018.

Surgeries for lumbar radiculopathy/sciatica are covered, with conditions.

Conditions of Coverage:

Open discectomy or microdiscectomy with or without endoscopy (lumbar laminectomy, laminotomy, discectomy, foraminotomy) are covered with the following conditions:

  • For adult patients with lumbar radiculopathy with subjective and objective neurologic findings that are corroborated with an advanced imaging test (i.e., Computed Tomography (CT) scan, Magnetic Resonance Imaging (MRI) or myelogram), AND

  • There is a failure to improve with a minimum of six weeks of non-surgical care, unless progressive motor weakness is present

Non-covered indicators:

Minimally invasive procedures that do not include laminectomy, laminotomy, or foraminotomy including but not limited to energy ablation techniques, Automated Percutaneous Lumbar Discectomy (APLD), percutaneous laser, nucleoplasty, etc. are not covered.

Background Information:

The State Health Technology Clinical Committee (HTCC) reviewed surgery for lumbar radiculopathy/sciatica in May 2018 and finalized the determination on July 13, 2018. Complete information on this HTCC determination is available here.

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).

Implementation of the Coverage Decision:

All requests for surgery for lumbar radiculopathy/sciatica require prior authorization. The service may be covered only for care of a condition accepted on or related to the claim.

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