Automatic authorization for California workers’ comp is in effect, but not all treatments qualify.
In fact, the Division of Workers’ Compensation (DWC) has specifically barred certain treatments from automatic authorization. In these cases, the usual Request for Authorization (RFA) and prospective utilization review remains required — with some exceptions. Since many of our recent webinar attendees asked about specific services, we thought a review of ineligible treatments was in order.
Automatic authorization became effective January 1. Since then, we’ve helped readers and DaisyBill clients navigate the new rules, especially regarding eligibility and submission deadlines. At our recent webinar, attendees asked about everything from occupational therapy to cortisone injections, wondering whether each treatment made the cut.
To review, for a treatment to qualify for automatic authorization, it must meet 6 qualifying conditions per the revised Labor Code § 4610:
Of the six, numbers 4 and 6 specifically address the treatment in question. When considering a treatment’s eligibility, providers should first ask:
To be sure the treatment is included in the MTUS, providers can consult the DWC website’s MTUS page. As for the second question, below are the treatments specifically excluded from eligibility by the Labor Code.
LAB 4610 also grants the DWC Administrative Director the right to exclude any other treatments from automatic authorization, at his discretion.
While the Labor Code expressly bars automatic authorization for the treatments listed above, those exclusions are subject to a few exceptions:
Like most things in workers’ compensation, automatic authorization is complicated. Be sure to know the rules, and stay informed of any changes as this new system evolves. As always, we’ll keep our readers up to speed.
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DaisyBill provides content as an insightful service to its readers and clients. It does not offer legal advice and cannot guarantee the accuracy or suitability of its content for a particular purpose.