New York State Workers’ Compensation Board Medical Treatment Guidelines became effective in December 2010. The Guidelines pertain to injuries involving the neck, back, shoulder, and knee. More recently treatment guidelines for carpal tunnel syndrome have been published. Additionally, non-acute pain guidelines and updated versions of the other five medical treatment guidelines went into effect for treatments given on or after December 15, 2014.
You can view the Guidelines below:
- Neck Injury Medical Treatment Guidelines
- Mid or Low Back Injury Medical Treatment Guidelines
- Shoulder Injury Medical Treatment Guidelines
- Knee Injury Medical Treatment Guidelines
- Carpal Tunnel Medical Treatment Guidelines
- Non-Acute Pain Medical Treatment Guidelines
What Are the Medical Treatment Guidelines?
The guidelines are mandatory standards of care for work-related injuries. These guidelines define the type of care deemed appropriate for these injuries and preapproved for workers’ compensation coverage. You do not have to seek authorization for treatments outlined in the Guidelines, which saves you and your medical providers time.
Making Sure Your Doctor Is Familiar with the Guidelines
Your doctor’s familiarity with the specific modalities of treatment found in the Guidelines could make a huge difference in your medical care. A doctor who is familiar with New York’s Guidelines will know that for many types of treatment he can simply provide the medical care without any pre-approval or authorization delays.
Treatment Outside of the Guidelines
However, if the treatment being recommended is not listed in the Guidelines then treatment authorization must be obtained or a variance procedure must be utilized. Proper filing of treatment authorization or variance requests could be the difference between treatment being approved or denied.
However, if the treatment being recommended is not listed in the Guidelines then a variance procedure must be utilized. Proper filing of variance requests could be the difference between treatment being approved or denied.
A request for treatment authorization must be used when asking for a special service costing more than $1,000 in a non-emergency situation. Pre-authorization is also required for:
- Lumbar fusions
- Artificial disk replacement
- Electrical bone growth stimulators
- Spinal Cord Stimulators
- Osteochondral autograft
- Autologous chondrocyte implantation
- Meniscal allograft transplantation
- Total or partial knee replacement
- A repeat surgery due to failure of the first
Special Services, Variance Requests, and Treatment Authorization Requests
Special services that require pre-authorization are outlined in the Guidelines related to your injury.
Variance requests differ from pre-authorizations. A variance request is necessary when your doctor wishes to provide a treatment that is inconsistent with the Guidelines.
Treatment authorization requests and variance requests are two different forms, which is another reason why it is important for your doctor to be knowledgeable regarding the Guidelines.
It is in your best interest to confirm that your physician is familiar with the New York Guidelines beginning treatment at his or her office. This will make delivery of your medical care a much simpler and effective process.