Table of contents

5221.6020 Purpose and Application

Subpart 1. Purpose

Subp. 2. Application

5221.6030 Incorporate by Reference

5221.6040 Definitions

Subpart 1. Scope

Subp. 2. Active treatment

Subp. 3. Chronic pain syndrome

Subp. 4. Condition

Subp. 5. Emergency treatment

Subp. 6. Etiology

Subp. 7. Functional status

Subp. 8. Initial nonsurgical management or treatment

Subp. 8a. Medical contraindication

Subp. 9. Medical imaging procedures

Subp. 10. Medically necessary treatment

Subp. 11. Neurologic deficit

Subp. 12. Passive treatment

Subp. 13. Therapeutic injection

5221.6050 General Treatment Parameters; Excessive Treatment; Prior Notification

Subpart 1. General

Subp. 2. Documentation

Subp. 3. Nonoperative treatment

Subp. 4. Chemical dependency

Subp. 5. Referrals between health care providers

Subp. 6. Communication between health care providers and consideration of prior care

Subp. 7. Determinations of excessive treatment; notice of denial to health care providers and employee; expedited processing of medical requests

Subp. 8. Departure from parameters

Subp. 9. Prior notification; health care provider and insurer responsibilities

Subp. 10. Certified managed care plans

Subp. 11. Outcome studies

5221.6105 Medications

Subpart 1. Scope

Subp. 2. Nonsteroidal anti-inflammatory drugs (NSAIDs)

Subp. 3. Opiod analgesics

Subp. 4. Muscle relaxants

5221.6100 Parameters for Medical Imaging

Subpart 1. General principles

Subp. 2. Specific imaging procedures for low back pain

5221.6200 Low Back Pain

Subpart 1. Diagnostic procedures for treatment of low back injury

Subp. 2. General treatment parameters for low back pain

Subp. 3. Passive treatment modalities

Subp. 4. Active treatment modalities

Subp. 5. Therapeutic injections

Subp. 6. Surgery, including decompression procedures and arthrodesis

Subp. 7. Chronic management

Subp. 8. Durable medical equipment

Subp. 9. Evaluation of treatment by health care provider

Subp. 10. Scheduled and nonscheduled medication

Subp. 11. Specific treatment parameters for regional low back pain

Subp. 12. Specific treatment parameters for radicular pain, with or without regional low back pain, with no or static neurologic deficits

Subp. 13. Specific treatment parameters for cauda equina syndrome and for radicular pain, with or without regional low back pain, with progressive neurologic deficits

5221.6205 Neck Pain

Subpart 1. Diagnostic procedures for treatment of neck injury

Subp. 2. General treatment parameters for neck pain

Subp. 3. Passive treatment modalities

Subp. 4. Active treatment modalities

Subp. 5. Therapeutic injections

Subp. 6. Surgery, including decompression procedures and arthrodesis

Subp. 7. Chronic management

Subp. 8. Durable medical equipment

Subp. 9. Evaluation of treatment by health care provider

Subp. 10. Scheduled and nonscheduled medication

Subp. 11. Specific treatment parameters for regional neck pain

Subp. 12. Specific treatment parameters for radicular pain, with or without regional neck pain, with no or static neurologic deficits

Subp. 13. Specific treatment parameters for radicular pain, with or without regional neck pain, with progressive neurologic deficits

Subp. 14. Specific treatment parameters for myelopathy

5221.6210 Thoracic Back Pain

Subpart 1. Diagnostic procedures for treatment of thoracic back injury

Subp. 2. General treatment parameters for thoracic back pain

Subp. 3. Passive treatment modalities

Subp. 4. Active treatment modalities

Subp. 5. Therapeutic injections

Subp. 6. Surgery, including decompression procedures

Subp. 7. Chronic management

Subp. 8. Durable medical equipment

Subp. 9. Evaluation of treatment by health care provider

Subp. 10. Scheduled and nonscheduled medication

Subp. 11. Specific treatment parameters for regional thoracic back pain

Subp. 12. Specific treatment parameters for radicular pain

Subp. 13. Specific treatment parameters for myelopathy

5221.6300 Upper Extremity Disorders

Subpart 1. Diagnostic procedures for treatment of upper extremity disorders (UED)

Subp. 2. General treatment parameters for upper extremity disorders

Subp. 3. Passive treatment modalities

Subp. 4. Active treatment modalities

Subp. 5. Therapeutic injections

Subp. 6. Surgery

Subp. 7. Chronic management

Subp. 8. Durable medical equipment

Subp. 9. Evaluation of treatment by health care provider

Subp. 10. Scheduled and nonscheduled medication

Subp. 11. Specific treatment parameters for epicondylitis

Subp. 12. Specific treatment parameters for tendonitis of forearm, wrist, and hand

Subp. 13. Specific treatment parameters for nerve entrapment syndromes

Subp. 14. Specific treatment parameters for muscle pain syndromes

Subp. 15. Specific treatment parameters for shoulder impingement syndromes

Subp. 16. Specific treatment parameters for traumatic sprains and strains of the upper extremity

5221.6305 Complex Regional Pain Syndrome (CRPS); Reflex Sympathetic Dystrophy; and Causalgia of the Upper and Lower Extremities

Subpart 1. Scope

Subp. 2. Initial nonsurgical management

Subp. 3. Surgery

Subp. 4. Chronic management

5221.6400 Inpatient Hospitalization Parameters

Subpart 1. General principles

Subp. 2. Specific requirements for hospital admission of patients with low back pain

5221.6500 Parameters for Surgical Procedures

Subpart 1. Scope

Subp. 2. Spinal surgery

Subp. 3. Upper extremity surgery

Subp. 4. Lower extremity surgery

5221.6600 Chronic Management

Subpart 1. Scope

Subp. 2. Chronic management modalities

5221.8900 Disciplinary Action; Penalties

Subpart 1. Discipline

Subp. 2. Complaints

Subp. 3. Review and investigation

Subp. 4. Cooperation with disciplinary proceedings

Subp. 5. In-person meeting

Subp. 6. Resolution by instruction or written agreement

Subp. 7. Inappropriate, unnecessary, or excessive treatment

Subp. 8. Violations of statutes and rules other than those involving inappropriate, unnecessary, or excessive treatment

Subp. 9. Penalties