California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5.5.2 - Medical Treatment Utilization Schedule › Section 9792.21 - Medical Treatment Utilization Schedule

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The Administrative Director adopts the
					 Medical Treatment Utilization Schedule (MTUS) consisting of section
					 9792.20 through section
					 9792.26.
(b) The MTUS is based on the principals of
					 Evidenced-Based Medicine (EBM). EBM is a systematic approach to making clinical
					 decisions which allows the integration of the best available evidence with
					 clinical expertise and patient values. EBM is a method of improving the quality
					 of care by encouraging practices that work and discouraging those that are
					 ineffective or harmful. EBM asserts that intuition, unsystematic clinical
					 experience, and pathophysiologic rationale are insufficient grounds for making
					 clinical decisions. Instead, EBM requires the evaluation of medical evidence by
					 applying an explicit systematic methodology to determine the quality and
					 strength of evidence used to support the recommendations for a medical
					 condition or injury. The best available evidence is then used to guide clinical
					 decision making.
(c) The
					 recommended guidelines set forth in the MTUS are presumptively correct on the
					 issue of extent and scope of medical treatment. The MTUS constitutes the
					 standard for the provision of medical care in accordance with Labor Code
					 section
					 4600 for all
					 injured workers diagnosed with industrial conditions because it provides a
					 framework for the most effective treatment of work-related illness or injury to
					 achieve functional improvement, return-to-work, and disability prevention. The
					 MTUS shall be the primary source of guidance for treating physicians and
					 physician reviewers for the evaluation and treatment of injured
					 workers.
(d) Treatment shall not be
					 denied on the sole basis that the condition or injury is not addressed by the
					 MTUS. There are two limited situations that may warrant treatment based on
					 recommendations found outside of the MTUS.
(1)
					 First, if a medical condition or injury is not addressed by the MTUS, medical
					 care shall be in accordance with other medical treatment guidelines or
					 peer-reviewed studies found by applying the Medical Evidence Search Sequence
					 set forth in section
					 9792.21.1.
(2) Second, if the MTUS' presumption of
					 correctness is successfully challenged. The recommended guidelines set forth in
					 the MTUS are presumptively correct on the issue of extent and scope of medical
					 treatment. The presumption is rebuttable and may be controverted by a
					 preponderance of scientific medical evidence establishing that a variance from
					 the schedule is reasonably required to cure or relieve the injured worker from
					 the effects of his or her injury. The presumption created is one affecting the
					 burden of proof. Therefore, the treating physician who seeks treatment outside
					 of the MTUS bears the burden of rebutting the MTUS' presumption of correctness
					 by a preponderance of scientific medical evidence.