1. DWC

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.

Note: Any and all commercial use of the MTUS/ACOEM Guidelines requires a license from Reed Group, Ltd. 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 for a license at https://www.mdguidelines.com/MTUS. Others may purchase a license by contacting mtus@reedgroup.com.

Administrative Director Orders (Lab. Code, § 5307.27)

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. Always begin your search with the ACOEM guidelines adopted into the MTUS. 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.

Contact us

Questions may be submitted to the DWC MTUS email box at mtus@dir.ca.gov.

Resources

  • Medical treatment utilization schedule Webinar November 14 and 15, 2017
  • MTUS Drug Formulary Webinar 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).

What's
New

October 2024