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Medical Treatment Guidelines

Medical Treatment Guidelines FAQ


  • What is the purpose of the treatment guidelines?

    The purpose of the treatment guidelines is to facilitate evidence-based, safe and appropriate medical treatment of work-related injuries and occupational diseases, in order to expedite recovery of health and return to work.

  • Why has the Department of Workers’ Claims established the treatment guidelines?

    House Bill 2 (2018) mandated that the commissioner of the Department of Workers’ Claims develop or adopt practice parameters or evidence-based guidelines for use by medical providers under KRS Chapter 342 (the Workers’ Compensation Act).  That legislation further required the commissioner to promulgate administrative regulations to implement the guidelines on or before December 31, 2019.  The commissioner has adopted the ODG by MCG Health (“ODG”) medical treatment guidelines for this purpose.

  • What are the ODG guidelines?

    The ODG guidelines contain independent, evidence-based, nationally recognized treatment guidelines for the most common work-related injuries and conditions. ODG published its first treatment guidelines in 2003. Since then, ODG’s treatment guidelines, and/or the drug formulary included as Appendix A to the guidelines, have been adopted by 11 state workers’ compensation systems including Kentucky.  ODG’s guidelines are web-based and can be found at

  • What can I expect to find in ODG?

    ODG’s treatment guidelines contain a comprehensive list of treatments that may be prescribed for injuries to specific body parts or for general conditions based on diagnosis. The guidelines are organized by body system. Potential treatment procedures are  listed as either recommended, not recommended, or conditionally recommended. Each guideline is based on a comprehensive and ongoing review of medical literature that is ranked in terms of its scientific medical reliability. The methodology used by ODG can be found in Appendix B of the treatment guidelines, provides regular training webinars, and additional training tools can be found for subscribers at or the public at

  • Who develops and authors the guidelines?

    ODG’s treatment guidelines are created by independent physicians and healthcare professionals trained in the review and analysis of evidence-based medical studies and literature. ODG relies on an Editorial Advisory Board composed of approximately 100 health care professionals. The Editorial Advisory Board is multidisciplinary in scope, representing the medical specialties most-commonly involved in treating workplace injuries and occupational diseases (occupational medicine, neurosurgeons, orthopedic surgeons, physical therapists, chiropractors, etc.). Unlike medical specialty society guidelines, ODG does not represent the interests of any one provider-group over others. Rather, it represents the wide multitude of specialties involved in the treatment of injured workers.

  • Are the ODG treatment guidelines evidence-based?

    Yes, ODG is evidence-based and each treatment recommendation is linked to the supporting medical evidence. Each guideline includes links to the underlying medical studies, provided in abstract form, which are ranked, highlighted, and indexed. Full text copies of these studies are used by physician editors in formulating recommendations and are available on request. Procedures for suggesting changes to the guidelines can be found at

  • How are the ODG treatment guidelines developed?

    The ODG treatment guidelines are developed according to the AGREE Instrument. AGREE stands for “Appraisal of Guidelines Research and Evaluation". It originates from an international collaboration of researchers and policy makers who work together to improve the quality and effectiveness of clinical practice guidelines by establishing a shared framework for their development, reporting, and assessment. Further details concerning ODG’s methodology are provided in Appendix B of the guidelines, which may be found at

  • How often is ODG updated?

    ODG is continuously updated.  Beginning in 2021, ODG will utilize a quarterly publishing schedule, reflecting the findings of new studies as they are conducted and released. In addition to the supporting evidence, each guideline includes the date on which it was last updated. Further, ODG undergoes a comprehensive annual update process based on scientific medical literature review, claims data analysis, and expert panel validation.

  • How can I access ODG?

    ODG is a subscription-based website. Individuals or companies can purchase licenses to access ODG on the Web.  ODG is also available for integration into software platforms. The ODG treatment guidelines and drug formulary can be found for subscribers at, and subscription inquiries can be made at Questions concerning subscriptions may also be submitted to the ODG Help Desk at, or by telephone to (800) 488-5548 or (760) 753-9992. The ODG State formulary is available without subscription at

  • What is the cost of an ODG license?

    Subscription for ODG are typically licensed on an annual basis, and prices vary based on organizational size and type, as measured by the number of claims management and/or medical staff (i.e. healthcare providers and/or case managers). Kentucky individual subscribers receive 50% off the current subscription price.

  • When do the treatment guidelines go into effect?

    January 1, 2021.


  • What is preauthorization?

    Preauthorization means the process whereby payment for a medical service or course of treatment is assured in advance by the insurance carrier.

  • What happens when you do not receive preauthorization?

    The medical provider who has requested preauthorization may request a reconsideration of the preauthorization denial and may request a peer-to-peer telephone conference with a reviewing physician.  Denials at the preauthorization stage may occur for reasons unrelated to medical necessity, such as lack of work-relatedness or non-compensability of the claim.

  • Is preauthorization always required for treatment?

    For treatment designated as “Recommended” in the ODG guidelines, preauthorization is not required.  For Treatment designated as “Not Recommended,” preauthorization is required.  When a request is made for preauthorization for treatment designated as “Conditionally Recommended,” the insurance company must consider any sound medical reasoning submitted by the medical provider and may not deny preauthorization based solely on the basis that conditions precedent have not been met.

  • If a treatment is not recommended by ODG is it possible the treatment could still be provided?

    Yes. While the ODG guidelines offer the most current evidence based medical treatment guidance, there are situations where injured workers require medical care outside of the ODG treatment guidelines. In these situations, where the medical care is a variance to or outside the scope of ODG, the health care provider should document the treatment planning rationale according to ‘Documentation requirements for exceptions,’ which can be found at

​Utilization Review

  • What is the difference between preauthorization and utilization review (UR)?

    Preauthorization is defined in the section above.  Utilization review means a review of the medical necessity and appropriateness of medical care and services for purposes of recommending payments for a compensable injury or disease. The UR process will result in the treatment being either “certified” (approved) of “non-certified” (denied).

  • Can an injured worker or a medical provider appeal a UR denial of treatment?

    Yes.  Either may request reconsideration of the denial and the medical provider may request a telephone conference with the physician performing the UR reconsideration.  If such a request is made, the medical provider will select the date and time for the conference and the reviewing physician must be of the same medical specialty as the treating medical provider.

​Contact Infomation

  • Whom should I contact if I have a question about the treatment guidelines?

    Questions may be directed to, Scott C. Wilhoit, Division of Specialist & Medical Services, 502-564-5550 or Questions concerning the ODG by MCG platform and/or subscriptions should be directed to the ODG Help Desk at, or by telephone to (800) 488-5548 or (760) 753-9992.