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
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
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
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.
Cal. Code Regs. Tit.
Note: Authority cited: Sections
Code. Reference: Sections
1. New section
filed 6-15-2007; operative 6-15-2007 pursuant to Government Code section
(Register 2007, No. 24).
2. Amendment of subsection (a),
renumbering of former subsection (a)(1) to section 9792.22, subsection (a),
renumbering of former subsections (a)(2)-(a)(2)(E) to new section 9792.24.1 and
amendment of subsections (b) and (c) filed 6-18-2009; operative 7-18-2009
(Register 2009, No. 25).
3. Editorial correction of operative date
in History 2 (Register 2009, No. 30).
4. Amendment of section and
Note filed 4-20-2015; operative 4-20-2015 pursuant to Government Code section
2015, No. 17).