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:

• Neck and Upper Back Complaints
• Elbow Complaints
• Forearm, Wrist, and Hand Complaints
• Low Back Complaints
• Knee Complaints
• Ankle and Foot Complaints
• Pain, Suffering, and the Restoration of Function

The frequency and duration of treatment is delimited as follows:

• Time to produce functional improvement: 3 to 6 treatments
• Frequency: 1 to 3 times per week
• Optimum duration: 1 to 2 months

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:

• Adoption and incorporation of the American College of Occupational and Environmental Medicine's Occupational Medicine Practice Guidelines (ACOEM Practice Guidelines) into the MTUS;
• Establishment of the presumption of correctness of the MTUS, the burden of proof, and the strength of evidence rating methodology to evaluate specific medical treatment or diagnostic services; and
• Creation of a medical evidence evaluation advisory committee which will advise the DWC medical director on matters concerning the MTUS for purposes of revising, updating, and supplementing the MTUS as necessary.

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.