N.Y. Comp. Codes R. & Regs. tit. 12 § 324.2

Current through Register Vol. 46, No. 45, November 2, 2024

Section 324.2 - Medical treatment guidelines

(a) Medical Treatment Guidelines. Regardless of the date of accident or date of disablement, treatment of on the job injuries, illnesses, or occupational diseases shall be consistent with the applicable Medical Treatment Guidelines set forth herein. The operative Medical Treatment Guidelines shall be the Medical Treatment Guidelines in place on the date on which medical services are rendered. All Treating Medical Providers shall treat all existing and new workers' compensation injuries, illnesses, or occupational diseases, except as provided in section 324.3 of this Part, in accordance with the following:

(1) for the lumbar and thoracic spine before May 2, 2022, the New York Mid and Low Back Injury Medical Treatment Guidelines, Third Edition, September 15, 2014, effective November 1, 2014, which is herein incorporated by reference; for lumbar and thoracic spine treatment rendered on or after May 2, 2022, the New York Mid and Low Back Injury Medical Treatment Guidelines, Fourth Edition, January 26, 2021, effective May 2, 2022, which is herein incorporated by reference;

(2) for the cervical spine before May 2, 2022, the New York Neck Injury Medical Treatment Guidelines, Third Edition, September 15, 2014, effective November 1, 2014, which is incorporated herein by reference; for cervical spine treatment rendered on or after May 2, 2022, the New York Neck Injury Medical Treatment Guidelines, Fourth Edition, January 26, 2021, effective May 2, 2022, which is herein incorporated by reference;

(3) for the knee before May 2, 2022, with the New York Knee Injury Medical Treatment Guidelines, Third Edition, September 15, 2014, effective November 1, 2014, which is incorporated herein by reference; for knee treatment rendered on or after May 2, 2022, the New York Knee Injury Medical Treatment Guidelines, Fourth Edition, January 26, 2021, effective May 2, 2022, which is herein incorporated by reference;

(4) for the shoulder before May 2, 2022, the New York Shoulder Injury Medical Treatment Guidelines, Third Edition, September 15, 2014, effective November 1, 2014, which is incorporated herein by reference; for shoulder treatment rendered on or after May 2, 2022, the New York Shoulder Injury Medical Treatment Guidelines, Fourth Edition, January 26, 2021 effective May 2, 2022, which is herein incorporated by reference;

(5) for treatment of carpal tunnel syndrome before May 2, 2022, the New York Carpal Tunnel Syndrome Medical Treatment Guidelines, Second Edition, September 15, 2014, effective November 1, 2014, which is incorporated herein by reference;

(6) for non-acute pain before May 2, 2022, the New York Non-Acute Pain Medical Treatment Guidelines, First Edition, September 15, 2014, effective November 1, 2014, which is incorporated herein by reference; for non-acute pain treatment rendered on or after May 2, 2022, the New York Non-Acute Pain Medical Treatment Guidelines, Second Edition, March 25, 2021, effective May 2, 2022, which is herein incorporated by reference;

(7) for the hip and groin, the New York Hip/Groin Medical Treatment Guideline, First Edition, March 18, 2020, effective May 2, 2022, which is incorporated herein by reference;

(8) for the foot and ankle, the New York Foot/Ankle Medical Treatment Guideline, First Edition, March 18, 2020, effective May 2, 2022, which is incorporated herein by reference;

(9) for the elbow, the New York Elbow Medical Treatment Guideline, first edition, March 18, 2020 effective May 2, 2022, herein incorporated by reference;

(10) for occupational interstitial lung disease, the New York Occupational Interstitial Lung Disease Medical Treatment Guideline, first edition, March 18, 2020, effective May 2, 2022, herein incorporated by reference;

(11) for asthma, the New York Asthma Medical Treatment Guideline, first edition, May 12, 2020, effective May 2, 2022, herein incorporated by reference;

(12) for hand, wrist and forearm, including treatment for carpal tunnel syndrome rendered on or after May 2, 2022, the New York Hand, Wrist & Forearm Medical Treatment Guideline, first edition, May 12, 2020, effective May 2, 2022, herein incorporated by reference;

(13) for post-traumatic stress disorder and acute stress disorder, the New York Post-traumatic Stress Disorder and Acute Stress Disorder Medical Treatment Guideline, first edition, September 15, 2020, effective May 2, 2022, herein incorporated by reference;

(14) for depression, the New York Work-Related Depression and Depressive Disorders Medical Treatment Guideline, first edition, September 15, 2020, effective May 2, 2022, herein incorporated by reference;

(15) for eye disorders, the New York Eye Disorders Medical Treatment Guidelines, first edition, September 28, 2021, effective May 2, 2022, herein incorporated by reference;

(16) for traumatic brain injury, the New York Traumatic Brain Injury Medical Treatment Guidelines, first edition, September 28, 2021, effective May 2, 2022, herein incorporated by reference; and

(17) for complex regional pain syndrome, the New York Complex Regional Pain Syndrome Medical Treatment Guidelines, first edition, September 28, effective May 2, 2022, herein incorporated by reference.

(b) Obtaining the medical treatment guidelines. The New York Medical Treatment Guidelines incorporated by reference herein may be examined at the office of the Department of State, 99 Washington Avenue, Albany, New York, 12231, the Legislative Library, the libraries of the New York State Supreme Court, and the district offices of the Board. Copies may be downloaded from the Board's website without a fee at wcb.ny.gov.

(c) Limitations. The Medical Treatment Guidelines in subdivision (a) of this section and this Part are not intended to, and were not prepared with the expectation of, establishing a standard for determining professional liability.

(d) Applicability and Pre-authorized procedures list.

All medical care consistent with the Medical Treatment Guidelines costing more than $1,000 is included on the pre-authorized procedures list, except as set forth in section 324.3 herein . Medical care costing more than $1,000 included in a Medical Treatment Guideline is pre-authorized so Treating Medical Providers are not required to request prior authorization. Medical care that is not included in the applicable Medical Treatment Guidelines may only be provided in accordance with section 324.3 herein. A Treating Medical Provider may confirm that medical care is consistent with the Medical Treatment Guidelines or, when there is not an applicable Medical Treatment Guideline and the total cost for the aggregate of such medical care is less than $1000, may confirm the medical necessity of causally related medical care by submitting a request in accordance with section 324.4 herein.

(e) Variances from the Medical Treatment Guidelines are permissible only as provided in section 324.3 of this Part.

(f) Maximum medical improvement shall not preclude the provision of medically necessary care for claimants. Such care shall be medically necessary to maintain function at the maximum medical improvement level or to improve function following an exacerbation of the claimant's condition. Post-maximum medical improvement medical services shall conform to the relevant Medical Treatment Guidelines, except as provided in section 324.3 of this Part.

N.Y. Comp. Codes R. & Regs. Tit. 12 § 324.2

Amended, New York State Register November 26, 2014/Volume XXXVI, Issue 47, eff. 12/15/2014

Amended New York State Register May 20, 2020/Volume XLII, Issue 20, eff. 5/20/2020

Amended New York State Register September 16, 2020/Volume XLII, Issue 37, eff. 9/23/2020

Amended New York State Register March 3, 2021/Volume XLIII, Issue 09, eff. 6/7/2021

Amended New York State Register September 1, 2021/Volume XLIII, Issue 35, eff. 9/1/2021

Amended New York State Register March 2, 2022/Volume XLIV, Issue 09, eff. 3/2/2022

Amended New York State Register June 21, 2023/Volume XLV, Issue 25, eff. 6/21/2023