Medical Treatment Utilization Schedule
When an employee is injured at work, he or she is entitled to receive reasonable and necessary medical treatment to cure or relieve the injury. The Medical Treatment Utilization Schedule (MTUS) is a set of regulations found in title 8, California Code of Regulations section 9792.20 through 9792.27.23 that contain medical treatment guidelines and rules for determining what is reasonable and necessary medical care. The MTUS is based on the principles of evidence-based medicine. That means treatment decisions are guided by recommendations supported by the best-available evidence.
ACOEM Treatment Guidelines
The MTUS contains medical treatment guidelines that were adopted into the MTUS through the formal rulemaking process or by Administrative Director Order. These guidelines are considered the core of the MTUS because they are presumed correct on the issue of extent and scope of medical treatment. This means that the adopted ACOEM Guidelines should guide treatment decisions in most cases.
The MTUS has adopted treatment guidelines developed by the American College of Occupational and Environmental Medicine (ACOEM). In most cases, medical treatment that is reasonable and necessary to cure or relieve an injured worker from the effects of injury means treatment that is based upon the ACOEM treatment guidelines adopted in the MTUS.
Healthcare providers treating, evaluating, or performing utilization review in the California workers’ compensation system may access the MTUS (ACOEM) Guidelines and MTUS Drug List at no cost by registering at https://www.mdguidelines.com/MTUS.
Administrative Director Order Making Evidence-Based Updates to the MTUS:
- AD Order Effective December 1, 2017
- AD Order Effective October 31, 2018
- AD Order Effective April 18, 2019
- AD Order Effective August 11, 2019
- AD Order Effective October 7, 2019
ACOEM Coronavirus (COVID-19) Guide
The American College of Occupational and Environmental Medicine (ACOEM) and MDGuidelines® have released a Coronavirus (COVID-19) Clinical Practice Guideline.
The Division of Workers’ Compensation (DWC) supports this guidance and plans on adopting and incorporating the ACOEM Coronavirus (COVID-19) Guideline into the Medical Treatment Utilization Schedule (MTUS).
However, at this time, the evidence-base addressing the management of this disease is evolving at such a rapid pace that updates to this guideline are being published frequently. As a result, DWC will wait to adopt and incorporate ACOEM's COVID-19 Guideline into the MTUS until the frequency of updates has slowed to the point that the formal guideline adoption process can be completed.
In the meantime, follow the MTUS Medical Evidence Search Sequence found in California Code of Regulations, title 8, section 9792.21.1, for treatment recommendations pertaining to COVID-19. This regulatory search sequence requires a search of the most current version of ACOEM guidance. The ACOEM COVID-19 Guideline meets that criteria.
MTUS Regulations – Conditions Not Covered by the Treatment Guidelines; Rebutting the Guidelines
The MTUS regulations also contain rules to determine what is reasonable and necessary care in the two limited situations that may warrant treatment based on recommendations found outside of the MTUS treatment guidelines. Recommendations found in the MTUS guidelines are presumed correct and will automatically be applied to guide patient care, unless the injured worker’s injury or condition is not addressed by an MTUS medical treatment guideline or if the treating physician disagrees with its recommendations and wishes to rebut the presumption of correctness.
The MTUS regulations describe the medical evidence search sequence that guides the order in which a search for medical evidence shall occur and also establishes the methodology that shall be applied by reviewing physicians when evaluating conflicting recommendations. The MTUS is based on the principles of evidence-based medicine. The MTUS regulations establish a systematic methodology to determine the quality and strength of evidence used to support treatment recommendations for a medical condition or injury. Recommendations supported by the best available evidence shall be used to guide treatment decisions.
MTUS - Drug Formulary
The Division of Workers’ Compensation has adopted a drug formulary as part of the MTUS to implement Assembly Bill 1124 (Statutes 2015, Chapter 525). The regulations establish an evidence-based drug formulary, consistent with California’s Medical Treatment Utilization Schedule (MTUS), to augment the provision of high-quality medical care, maximize health, and promote return to work in a timely fashion, while reducing administrative burden and cost.
The MTUS regulations include the MTUS formulary, which is evidence-based and built on the foundation of the MTUS treatment guidelines recommendations.
Questions may be submitted to the DWC MTUS email box at email@example.com.
- Medical treatment utilization schedule Webinar - Transcript - November 14 and 15, 2017
- MTUS Drug Formulary Webinar - Transcript - December 13 and 14, 2017
The webinar provides an overview of the MTUS Drug Formulary regulations, including the adoption of the drug list, implementation of updated MTUS guidelines, a demo of the online formulary tools for pharmaceutical searches.
- Coming soon: revised frequently asked questions about the medical treatment utilization schedule (including evidence-based updates)
- Disclosure of conflicts of interest - (MEEAC)
- Online physician education courses now available
DWC offers free online education courses providing continuing education credits for physicians, QMEs, chiropractors, and nurses. Current offerings include the use of the Medical Treatment Utilization Schedule (MTUS) and tips for Qualified Medical Evaluators (QME).