California Regulations 9792.21 1205

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§ Medical Treatment Utilization Schedule



(a) The Administrative Director adopts the Medical Treatment Utilization Schedule consisting of Sections 9792.20 through Section 9792.23. The Administrative Director adopts and incorporates by reference the following medical treatment guidelines into the Medical Treatment Utilization Schedule:

(1) The American College of Occupational and Environmental Medicine�s Occupational Medicine Practice Guidelines (ACOEM Practice Guidelines), Second Edition (2004). A copy may be obtained from the American College of Occupational and Environmental Medicine, 25 Northwest Point Blvd., Suite 700, Elk Grove Village, Illinois, 60007-1030 (www.acoem.org).

(2) Acupuncture Medical Treatment Guidelines The Acupuncture Medical Treatment Guidelines set forth in this subdivision shall supersede the text in the ACOEM Practice Guidelines, Second Edition, relating to acupuncture, except for shoulder complaints, and shall address acupuncture treatment where not discussed in the ACOEM Practice Guidelines.

(A) Definitions:

(i) "Acupuncture" is used as an option when pain medication is reduced or not tolerated, it may be used as an adjunct to physical rehabilitation and/or surgical intervention to hasten functional recovery. It is the insertion and removal of filiform needles to stimulate acupoints (acupuncture points). Needles may be inserted, manipulated, and retained for a period of time. Acupuncture can be used to reduce pain, reduce inflammation, increase blood flow, increase range of motion, decrease the side effect of medication-induced nausea, promote relaxation in an anxious patient, and reduce muscle spasm.

(ii) "Acupuncture with electrical stimulation" is the use of electrical current (microamperage or milli-amperage) on the needles at the acupuncture site. It is used to increase effectiveness of the needles by continuous stimulation of the acupoint. Physiological effects (depending on location and settings) can include endorphin release for pain relief, reduction of inflammation, increased blood circulation, analgesia through interruption of pain stimulus, and muscle relaxation. It is indicated to treat chronic pain conditions, radiating pain along a nerve pathway, muscle spasm, inflammation, scar tissue pain, and pain located in multiple sites.

(iii) "Chronic pain for purposes of acupuncture" means pain that persists for at least 30 days beyond the usual course of an acute disease or a reasonable time for an injury to heal or that is associated with a chronic pathological process that causes continuous pain (e.g., reflex sympathetic dystrophy). The very definition of chronic pain describes a delay or outright failure to relieve pain associated with some specific illness or accident.

(B) Indications for acupuncture or acupuncture with electrical stimulation include the following presenting complaints in reference to the following ACOEM Practice Guidelines Chapter Headings:

(i) Neck and Upper Back Complaints

(ii) Elbow Complaints

(iii) Forearm, Wrist, and Hand Complaints

(iv) Low Back Complaints

(v) Knee Complaints

(vi) Ankle and Foot Complaints

(vii) Pain, Suffering, and the Restoration of Function

(C) Frequency and duration of acupuncture or acupuncture with electrical stimulation may be performed as follows:

(i) Time to produce functional improvement: 3 to 6 treatments.

(ii) Frequency: 1 to 3 times per week

(iii) Optimum duration: 1 to 2 months

(D) Acupuncture treatments may be extended if functional improvement is documented as defined in Section 9792.20(e).

(E) It is beyond the scope of the Acupuncture Medical Treatment Guidelines to state the precautions, limitations, contraindications or adverse events resulting from acupuncture or acupuncture with electrical stimulations. These decisions are left up to the acupuncturist.

(b) The Medical Treatment Utilization Schedule is intended to assist in the provision of medical treatment by offering an analytical framework for the evaluation and treatment of injured workers and to help those who make decisions regarding the medical treatment of injured workers understand what treatment has been proven effective in providing the best medical outcomes to those workers, in accordance with section 4600 of the Labor Code.

(c) Treatment shall not be denied on the sole basis that the condition or injury is not addressed by the Medical Treatment Utilization Schedule. In this situation, the claims administrator shall authorize treatment if such treatment is in accordance with other scientifically and evidence-based, peer-reviewed, medical treatment guidelines that are nationally recognized by the medical community, in accordance with subdivisions (b) and (c) of section 9792.22, and pursuant to the Utilization Review Standards found in Section 9792.6 through Section 9792.10.

Authority: Sections 133, 4603.5, 5307.3, and 5307.27, Labor Code.

Reference: Sections 77.5, 4600, 4604.5, and 5307.27, Labor Code.