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Medical treatment utilization schedule (MTUS)

The medical treatment utilization schedule (MTUS) provides medical treatment guidelines for utilization review and an analytical framework for the evaluation and treatment of injured workers. It helps medical providers understand which evidenced-based treatments have been effective in providing improved medical outcomes to those workers. The MTUS is promulgated by the DWC administrative director under Labor Code sections 5307.27 and 4604.5, and can be found in sections 9792.20 et seq. of Title 8, California Code of Regulations.

The MTUS lays out treatments scientifically proven to cure or relieve work-related injuries and illnesses. It also deals with how often the treatment is given (frequency), extent of treatment (intensity), and for how long (duration), among other things.

This Web site provides a link to the MTUS regulations and to the guidelines adopted into the MTUS.

Content on this page:

History

Jan. 1, 2004 - The Legislature charged the DWC administrative director (AD) with adopting an MTUS that would be presumed correct on the issue of extent and scope of medical treatment, and made the American College of Occupational and Environmental Medicine Practice Guidelines, 2nd Edition, (ACOEM) the standard until the adoption of an MTUS by the AD.

June 15, 2007 - The date the MTUS became effective. Among other provisions, the MTUS regulations incorporated the American College of Occupational and Environmental Medicine's Occupational Medicine Practice Guidelines (ACOEM Practice Guidelines) and acupuncture guidelines. The rules also laid out the strength of evidence rating methodology by which specific medical treatments or diagnostic services are evaluated. The rules also established the medical evidence evaluation advisory committee (MEEAC).

July 18, 2009 - The date the MTUS was updated. The current version of the MTUS added new guidelines for chronic pain and postsurgical physical medicine treatment. The MTUS was also reorganized to restructure the MTUS into a clinical topics format, which will allow for easier updates of the guidelines.

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General approaches

The DWC administrative director adopts and incorporates specific guidelines into the MTUS set forth from the ACOEM Practice Guidelines for the chapters on prevention, general approach to initial assessment and documentation, initial approaches to treatment, cornerstones of disability prevention and management. The general approaches section of the MTUS are set forth in § 9792.22 of Title 8, California Code of Regulations and are based on chapters 1, 2, 3, and 5 as adopted from the ACOEM Practice Guidelines, 2nd edition (2004).

Copies of the ACOEM Practice Guidelines are available for review at local DWC offices. Copies of this publication may also be obtained from:

American College of Occupational and Environmental Medicine
25 Northwest Point Blvd., Suite 700
Elk Grove Village, Illinois, 60007-1030
www.acoem.org

Copying is restricted pursuant to the copyright language set forth in the utilization review page of this Web site. The ACOEM Practice Guidelines may not be published on the Internet or in any other media. All rights to the Guidelines are reserved by ACOEM. If you have any questions, please contact ACOEM. This applies to every clinical topic adopted from ACOEM that follow.

The remainder of the MTUS, which is not copyrighted by ACOEM can be reviewed and downloaded from the DWC Web site: http://www.dir.ca.gov/dwc/DWCPropRegs/MTUS_Regulations/MTUS_Regulations.htm.

Copies may also be obtained from:

Division of Workers' Compensation
Medical Unit
P.O. Box 71010
Oakland, CA 94612-1486

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Clinical topics

The clinical topics apply to the initial management and subsequent treatment of presenting complaints specific to the body part as set forth in § 9792.23.1 et seq. of Title 8, California Code of Regulations.

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Neck and upper back complaints

These guidelines are based on the neck and upper back complaints chapter as adopted from the ACOEM Practice Guidelines, 2nd edition (2004), chapter 8. Section 9792.23.1 of Title 8, California Code of Regulations sets forth the neck and upper back complaints clinical topic guidelines.

Special topics that apply to the neck and upper back complaints guidelines:

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Shoulder complaints

These guidelines are based on the shoulder complaints chapter as adopted from the ACOEM Practice Guidelines, 2nd edition (2004), chapter 9 and are set forth in § 9792.23.2 of Title 8, California Code of Regulations.

Special topics that apply to the shoulder complaints guidelines:

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Elbow disorders

These guidelines are based on the elbow disorders chapter as adopted from the ACOEM Practice Guidelines, 2nd Edition (Revised 2007), chapter 10 and are set forth in § 9792.23.3 of Title 8, California Code of Regulations.

Special topics that apply to the elbow disorders guidelines:

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Forearm, wrist, and hand complaints

These guidelines are based on the forearm, wrist, and hand complaints chapter as adopted from the ACOEM Practice Guidelines, 2nd edition (2004), chapter 11 and are set forth in § 9792.23.4 of Title 8, California Code of Regulations.

Special topics that apply to the forearm, wrist, and hand complaints guidelines:

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Low back complaints

These guidelines are based on the low back complaints chapter as adopted from the ACOEM Practice Guidelines, 2nd edition (2004), chapter 12 and are set forth in § 9792.23.5 of Title 8, California Code of Regulations.

Special topics that apply to the low back complaints guidelines:

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Knee complaints

These guidelines are based on the knee complaints chapter as adopted from the ACOEM Practice Guidelines, 2nd edition (2004), chapter 13 and are set forth in § 9792.23.6 of Title 8, California Code of Regulations.

Special topics that apply to the knee complaints guidelines:

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Ankle and foot complaints

These guidelines are based on the ankle and foot complaints chapter as adopted from the ACOEM Practice Guidelines, 2nd edition (2004), chapter 14 and are set forth in § 9792.23.7 of Title 8, California Code of Regulations.

Special topics that apply to the ankle and foot complaints guidelines:

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Stress related conditions

These guidelines are based on the stress related conditions chapter as adopted from the ACOEM Practice Guidelines, 2nd edition (2004), chapter 15 and are set forth in § 9792.23.8 of Title 8, California Code of Regulations.

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Eye

These guidelines are based on the eye chapter as adopted from the ACOEM Practice Guidelines, 2nd edition (2004), chapter 16 and are set forth in § 9792.23.9 of Title 8, California Code of Regulations.

Special topics that apply to the guidelines for eye related conditions:

  • Chronic pain medical treatment guidelines 8 - § 9792.24.2

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Special topics

The special topics of the MTUS addresses issues in common across the clinical topics and are set forth in § 9792.24.1 et seq. of Title 8, California Code of Regulations.

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Acupuncture medical treatment guidelines

The acupuncture guideline are set forth in § 9792.24.1 of Title 8, California Code of Regulations

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Chronic pain medical treatment guidelines

The chronic pain guidelines are set forth in § 9792.24.2 of Title 8, California Code of Regulations.The chronic pain guidelines (May 2009) consist of two parts and one appendix.

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Postsurgical treatment guidelines

The postsurgical treatment guidelines are set forth in § 9792.24.3 of Title 8, California Code of Regulations. These guidelines include two supporting documents.

  • Appendix C contains DWC's evidence-based review supporting the Postsurgical Treatment Guidelines
  • Appendix E contains Work Loss Data Institute-Official Disability Guidelines References for the Postsurgical Treatment Guidelines

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Presumption of correctness

The MTUS is presumed to be correct on the issue of extent and scope of medical treatment and diagnostic services it addresses. However, that presumption can be set aside by a preponderance of scientific medical evidence using strength of evidence criteria  to show that a variance from the schedule is reasonably required to cure or relieve the injured worker from the effects of his or her injury. For all conditions or injuries not addressed by the MTUS, authorized treatment and diagnostic services must be in accordance with other scientific, evidence-based medical treatment guidelines that are nationally recognized by the medical community as set forth in § 9792.25 of Title 8, California Code of Regulations.

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Medical evidence evaluation advisory committee (MEEAC)

To ensure California’s injured workers have access to effective and appropriate treatment, the MTUS regulations also created a medical evidence evaluation advisory committee (MEEAC), which meets regularly to review the latest medical evidence and advise the division about incorporating new evidence-based guidelines into its MTUS.

MEEAC provides recommendations to the administrative director on matters concerning the MTUS and advises the DWC medical director on potential revisions, updates and supplements that will keep California's treatment guidelines current.

MEEAC's recommendations are advisory in nature and do not constitute scientifically based evidence. The MEEAC members represent various medical fields. The regulations concerning the MEEAC are set forth in § 9792.26 of Title 8, California Code of Regulations. See disclosure of conflicts of interest.

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January 2010