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Uniform Medical Plan Headache Fact Sheet

Recently, Uniform Medical Plan (UMP) announced that starting January 1, 2018, massage therapy will no longer be covered for the treatment of chronic migraines and chronic tension-type headaches. This change is based on a decision by the Health Technology Clinical Committee (HTCC) in May 2017. Also affected by this decision are chiropractic treatments, acupuncture, trigger point injections, and transcranial magnetic stimulation.

The Washington State Health Care Authority’s Health Technology Assessment Program (HTA) conducted a review of existing research regarding the above treatment modalities and their effect on intermediate (6 months or more) and long-term (12 months or more)  prevention or reduction of chronic migraines and headaches. Short term reduction of frequency or intensity, and pain management were not considered in the review. Chronic headaches are defined as those occurring 15 or more days each month for at least 3 months or more than 180 days  a year.

Criteria were established for the inclusion of studies in the review, and only 1 massage therapy study was included. The final decision was based on “lack of scientific evidence”. The reviewers did not state that massage therapy was ineffective, but rather that not enough studies existed with a focus on long-term outcomes to determine it’s effectiveness.

What we don’t know is how this will affect coverage of headaches that are not classified as chronic migraines (ICD10 G437 + 2 digits) or chronic tension-type headaches (ICD10 G44221 & G44229).

UMP is legally bound to follow the HTCC’s decision. Protests by providers will likely have no impact. It will be up to UMP subscribers to argue their treatment needs and effects with their health plan.

For more information go to https://www.hca.wa.gov/about-hca/health-technology-assessment/treatment-chronic-migraine-and-chronic-tension-type-headache

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