New York Codes, Rules and Regulations › Title 12 - DEPARTMENT OF LABOR › Chapter V - Workers' Compensation › Subchapter C - Medical Treatment and Care › Part 324 - Medical Treatment Guidelines › Section 324.3 - Variances (PAR: MTG Variances)

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
				  Treating medical providers.
(1) Applicability
(i)
(a)
				  When a treating medical provider determines that medical care that varies from
				  the Medical Treatment Guidelines, such as when a treatment, procedure, or test
				  is not recommended by the Medical Treatment Guidelines, appropriate for the
				  claimant and medically necessary, he or she shall request a variance from the
				  insurance carrier, self-insured employer, or third party administrator by
				  submitting a prior approval request (PAR: MTG Variance) (hereinafter "PAR") in
				  the format prescribed by the chair for such purpose, which may be
				  electronic.
(b) In addition, prior
				  authorization for the following special services (PAR: Special Services) is
				  required:
(1) Lumbar fusion as set forth in
				  E.4 of the New York Mid and Low Back Injury Medical Treatment
				  Guidelines;
(2) Artificial disc
				  replacement as set forth in E.5 of the New York Mid and Low Back Injury Medical
				  Treatment Guidelines, and in E.3 of the New York Neck Injury Medical Treatment
				  Guidelines;
(3) Vertebroplasty as
				  set forth in E.6.a.i. of the New York Mid and Low Back Injury Medical Treatment
				  Guidelines;
(4) Kyphoplasty as set
				  forth in E.6.a.i. of the New York Mid and Low Back Injury Medical Treatment
				  Guidelines;
(5) Electrical bone
				  stimulation as set forth in the New York Mid and Low Back Injury Medical
				  Treatment Guidelines and the New York Neck Injury Medical Treatment
				  Guidelines;
(6) Osteochondral
				  autograft as set forth in D.1.f and Table 4 of the New York Knee Injury Medical
				  Treatment Guidelines;
(7)
				  Autologous chondrocyte implantation as set forth in D.1.f., Table 5, and D.1.g.
				  of the New York Knee Injury Medical Treatment Guidelines;
(8) Meniscal allograft transplantation as set
				  forth in D.6.f., Table 8, and D.7. of the New York Knee Injury Medical
				  Treatment Guidelines;
(9) Knee
				  arthroplasty (total or partial knee joint replacement) as set forth in F.2. and
				  Table 11 of the New York Knee Injury Medical Treatment Guidelines;
(10) Spinal Cord Pain Stimulators as set
				  forth in G.1 of the Non-Acute Pain Medical Treatment Guidelines;
(11) Intrathecal Drug Delivery (Pain Pumps)
				  as set forth in G.2 of the Non-Acute Pain Medical Treatment Guidelines
				  ;
(12) Sacroiliac joint (SIJ)
				  fusion as set forth in E.8 of the Mid and Low Back Medical Treatment
				  Guidelines; and
(13) Peripheral
				  Nerve Stimulation (PNS) as set forth in G.2 of the Non-Acute Pain Medical
				  Treatment Guidelines.
(c)
				  Notwithstanding that a surgical procedure is consistent with the guidelines, a
				  second or subsequent performance of such surgical procedure shall require a
				  PAR: special services if it is repeated because of the failure or incomplete
				  success of the same surgical procedure performed earlier, and if the medical
				  treatment guidelines do not specifically address multiple procedures.
(d) This section shall not apply to prior
				  authorization requests from the formulary, as set forth in Part 441 of this
				  chapter, or the durable medical equipment fee schedule, as set forth in Part
				  442 of this chapter.