Brain Imaging Questionnaire
Questionnaire for Washington Labor & Industries and Washington Medicaid brain imaging (MRI or CT scan).
Resource File
Cardiac Imaging Questionnaire
Questionnaire for Washington Labor & Industries and Washington Medicaid cardiac imaging.
Resource File
Cervical Spine MRI Questionnaire
Questionnaire for Washington Labor & Industries and Washington Medicaid cervical spine MRI.
Resource File
Lower Extremity MRI Questionnaire
Questionnaire for Washington Labor & Industries and Washington Medicaid lower extremity MRI.
Resource File
Washington Medicaid PET/CT Scan and PET Scan Questionnaire
Questionnaire for Washington Medicaid PET/CT scan and PET scan.
Resource File
Sacroiliac Joint Injection Questionnaire
Questionnaire for Washington Medicaid sacroiliac injection.
Resource File
Spinal Injection Procedure List
List of spinal injection codes requiring utilization review by Comagine Health for Washington Medicaid.
Resource File
Spinal Injection Request for Review Form
Form for submitting Washington Medicaid spinal injection authorization requests.
Resource File
Washington Medicaid Surgical Procedure Request for Review Form
Form for submitting Washington Medicaid surgical procedure authorization requests.
Resource File
Therapeutic Epidural Steroid Injection Questionnaire
Questionnaire for Washington Medicaid therapeutic epidural steroid injection.
Resource File