The Tennessee Workers’ Compensation Medical Advisory Committee held a public meeting on October 6th to assist the administrator in the development of the treatment guidelines and advise the administrator on issues relating to medical care in the workers’ comp system.
Healthesystems attended the meeting to capture key discussion points, which included ODG updates, legislative and rulemaking activity, the AMA Guides, mental health claim trends, and utilization review enforcement.
The ODG announced updates on October 1, 2026. A preliminary review did not identify any changes that appeared particularly relevant to Tennessee claims, but the committee will review the full update list at its December meeting. The Bureau also posted on its website Tennessee-specific supplemental spine treatment recommendations, including guidance on sacroiliac joint fusion.
The committee reviewed six months of data related to cold therapy devices from a Tennessee supplier following earlier ODG discussions. In a small sample, insurer-approved use averaged 70 days for shoulder cases and 66 days for knee cases. Thirteen requests initially denied through utilization review were approved on appeal for at least 14 days, and all 13 patients reportedly wanted to continue using the devices after that period. In a separate small group, 22 of 24 patients reported that the devices reduced their use of pain medication.
No significant legislative developments were discussed. Proposed rule updates would add kratom to Tennessee’s Drug-Free Workplace program, consistent with legislation passed by the General Assembly, and revise claims-handling standards. Public rulemaking hearings for both proposals are scheduled for November 10, 2026.
After discussing training, cost, accessibility, reliability, and potential unintended consequences associated with the newer digital guidance, the committee voted to retain the 2008 published version of the AMA Guides.
Members raised concerns that certain network-contracted providers have not received the full benefit of Tennessee’s 40% April 1, 2026 fee-schedule increase. One therapy provider reported realizing only about 9% to 30% of the increase.
A recent WCRI study on mental health claims found that anxiety, depression, adjustment disorders, and PTSD represented more than 90% of mental-only and minor-physical-component claims. These categories accounted for less than 1% of Tennessee claims, though coding may understate volume. Across the states studied, lost-time claims with a minor physical component averaged $19,000 in medical costs, $27,000 in indemnity, and 33 weeks of disability, versus $7,400, $17,000, and 19 weeks for mental-only claims.
The Bureau’s utilization review program referred 18 matters to its penalty unit this year. Approximately half involved excessive or poorly organized medical-record submissions, including duplicate and billing records totaling 400 to 1,600 pages.
The committee’s next meetings are scheduled for December 8, 2026, and February 9, 2027.
