Draft Work Comp Guidelines Revised (Mar 30, 2007)
New Acupuncture Treatment Guidelines
On June 15, 2007, the Division of Workers’ Compensation’s (DWC) medical treatment utilization schedule (MTUS) final regulations were approved by the Office of Administrative Law (OAL). The MTUS regulations, commonly referred to as "medical treatment guidelines," are now finalized.
Most significantly, the new MTUS regulations adopt new treatment guidelines for acupuncture. The new guidelines are based upon existing guidelines for acupuncture in the Colorado Work Comp system.
The final acupuncture treatment guidelines explicitly allow the use of acupuncture and electro-acupuncture for a wide range of musculoskeletal conditions, specifically:
The frequency and duration of treatment is delimited as follows:
The new guidelines omit "shoulder complaints" on the grounds that the ACOEM guidelines address acupuncture as it relates to such complaints.
Comments submitted by CSOMA resulted in the removal of a proposed 14-treatment cap from the final regulation. If functional improvement is demonstrated, there is no maximum duration of treatment.
Other changes introduced by the new MTUS regulations include:
What The New Guidelines Mean
In short, the new acupuncture treatment guidelines supersede the ACOEM treatment guidelines. There is no longer a basis for denying acupuncture treatment on the basis of disputed efficacy. For all of the complaints listed above, acupuncture claims should be accepted for a minimum of three to six treatments.
Treatment duration may be extended beyond this minimum as long as functional improvement is demonstrated. For this reason, it is now more important than ever to clearly and accurately document functional improvement of an injured worker at each visit.
Regarding shoulder complaints, the ACOEM guidelines (2nd edition, p.204) state, "Some small studies have supported using acupuncture, but referral is dependent on the availability of experienced providers with consistently good outcomes." Because the new MTUS omits shoulder complaints, this section of the ACOEM guidelines remains presumptively correct and may be used to justify acupuncture treatment of the shoulder when medically necessary.
Head, eye, and stress-related injuries are not addressed in the new acupuncture guideline. It is safe to assume that acupuncture treatment will be routinely denied for such claims.
In our analysis, the new acupuncture guidelines should greatly reduce the widespread denials of acupuncture treatment based upon disputed efficacy. If you treat within the California Work Comp system, we want to hear about your experiences with the new guidelines. CSOMA has established a web feedback form for reporting difficulties with the new guidelines.
The full text of the approved regulations, as filed with the California Secretary of State, can be found on the DWC website.