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Regulations



 
9792.25.1....MTUS Methodology for Evaluating Medical Evidence
(a) When competing recommendations are cited to guide medical care, Utilization Review and Independent Medical Review physicians shall apply the MTUS Methodology for ...more
 
 
9792.26....Medical Evidence Evaluation Advisory Committee
(a) The Medical Director shall create a Medical Evidence Evaluation Advisory Committee (MEEAC) to provide recommendations to the Medical Director on matters concerning ...more
 
 
9792.27.1....Medical Treatment Utilization Schedule (MTUS) Drug Formulary - Definitions
  (b) “Authorization through prospective review” means authorization for proposed treatment obtained through the utilization review process set forth in ...more
 
 
9792.27.10....MTUS Drug List; Exempt Drugs, Non-Exempt Drugs, Unlisted Drugs, Prospective Review
(a) The MTUS Drug List is set forth by active drug ingredient(s).   (c) For a drug that is identified as “Non-Exempt,” authorization through prospective ...more
 
 
9792.27.11....Waiver of Prospective Review
Nothing in the MTUS Drug Formulary shall prohibit waiver of the prospective review requirement for a Non-Exempt or unlisted drug if the drug falls within a utilization ...more
 
 
9792.27.12....MTUS Drug List - Special Fill
(a) The MTUS Drug List identifies drugs that are subject to the Special Fill policy. Under this policy, a drug that usually requires prospective review because it is ...more
 
 
9792.27.13....MTUS Drug List - Perioperative Fill
(a) The MTUS Drug List identifies drugs that are subject to the Perioperative Fill policy. Under this policy, the Non-Exempt drug identified as a Perioperative Fill drug ...more
 
 
9792.27.14....Treatment Provided Under Applicable Health and Safety Regulations
The MTUS Drug Formulary and associated regulations do not relieve an employer of any responsibilities pursuant to applicable health and safety regulations such as the ...more
 
 
9792.27.15....MTUS Drug List
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9792.27.16....National Drug Codes, Unique Pharmaceutical Identifier - MTUS Drug List
(a) The Administrative Director may maintain and post on the DWC website a listing by National Drug Code, RxCUI (clinical drug concept unique identifier maintained by the ...more
 
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