The department or self-insurer will not allow nor pay for following treatment:
(1) Use of diapulse, thermatic (standard model only), spectrowave and superpulse machines on workers entitled to benefits under the Industrial Insurance Act.
(2) Iontophoresis; prolotherapy; acupuncture; injections of colchicine; injections of fibrosing or sclerosing agents; and injections of substances other than anesthetic or contrast into the subarachnoid space (intra-thecal injections).
(3) Treatment to improve or maintain general health (i.e., prescriptions and/or injection of vitamins or referrals to special programs such as health spas, swim programs, exercise programs, athletic-fitness clubs, diet programs, social counseling).
(4) Continued treatment beyond stabilization of the industrial condition(s), i.e., maintenance care, except where necessary to monitor prescription of medication necessary to maintain stabilization i.e., anti-convulsive, anti-spasmodic, etc.
(5) After consultation and advice to the department or self-insurer, any treatment measure deemed to be dangerous or inappropriate for the injured worker in question.
(6) Treatment measures of an unusual, controversial, obsolete, or experimental nature (see WAC 296-20-045
). Under certain conditions, treatment in this category may be approved by the department or self-insurer. Approval must be obtained prior to treatment. Requests must contain a description of the treatment, reason for the request with benefits and results expected.
(7) Therapeutic medial branch block injections, therapeutic intradiscal injections, and therapeutic facet injections of the spine.
(8) Transcutaneous, interferential, and percutaneous nerve stimulators used in the home setting, and all associated supplies and equipment.
[Statutory Authority: RCW 70.14.110
, 51.04.020, and 51.04.030. WSR 12-12-059, § 296-20-03002, filed 6/5/12, effective 7/6/12. Statutory Authority: RCW 70.14.120
, 51.04.020, 51.04.030. WSR 09-20-040, § 296-20-03002, filed 9/30/09, effective 11/1/09. Statutory Authority: RCW 51.04.020
, 51.04.030. WSR 06-15-110, § 296-20-03002, filed 7/18/06, effective 8/18/06. Statutory Authority: RCW 51.04.020
(4) and 51.04.030. WSR 86-06-032 (Order 86-19), § 296-20-03002, filed 2/28/86, effective 4/1/86; WSR 83-16-066 (Order 83-23), § 296-20-03002, filed 8/2/83. Statutory Authority: RCW 51.04.020
(4), 51.04.030, and 51.16.120(3). WSR 81-24-041 (Order 81-28), § 296-20-03002, filed 11/30/81, effective 1/1/82; WSR 81-01-100 (Order 80-29), § 296-20-03002, filed 12/23/80, effective 3/1/81; Order 76-34, § 296-20-03002, filed 11/24/76, effective 1/1/77.]