For injuries not currently covered under the Medical Treatment Guidelines does the C-4 Auth process still apply?

Yes. WCL § 13-a(5) provides that medical services costing more than $1000 to be valid and enforceable must be authorized by the Board or carrier. Any denial of such medical service must be within 30 calendar days from receipt of the request and "must be based on a conflicting second opinion rendered by a physician authorized by the board."

All treatment within the Medical Treatment Guidelines (Guidelines) for the mid and low back, neck, knee, and shoulder and based upon a correct application of the Guidelines are pre-authorized and do not need to go through the C-4AUTH process except for the following 13 procedures: lumbar fusion, artificial disc replacement, spinal cord stimulators, vertebroplasty, kyphoplasty, electrical bone stimulation, anterior acromioplasty, chondroplasty, osteochondral autograph, auto chondrocyte implantation, meniscal allograft transplanation, knee arthroplasty, and second or subsequent performance of a surgical procedure because of a failure or incomplete ... more.

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