AMA Guides® proposal submissions

On this page:

1. Comment on proposed changes
2. Proposal submission requirements
3. Evidentiary requirements
4. Citations

The AMA Guides to the Evaluation of Permanent Impairment is used by physicians and others who are involved in the impairment rating process. After the release of the AMA Guides® Sixth 2025, there will be no further updates to the AMA Guides Sixth Edition.

Comment process on content updates

Formal comment periods provided the public with the opportunity to learn and to express their opinions on anticipated changes to the AMA Guides. 

Interested parties and organizations who utilize the AMA Guides were invited to comment on the proposed changes to the medicine and impairment ratings. The AMA Guides Editorial Panel considered all available information and comments prior to adopting changes.

Proposal submission requirements

In conjunction with their combined expertise across several medical disciplines, the AMA Guides Editorial Panel adopted a comprehensive set of standards by which content updates were accepted.

The AMA Guides Sixth Edition was considered the foundation for all updates to the AMA Guides and each update to the AMA Guides were built upon the changes that preceded them (i.e., AMA Guides Sixth 2022 will build on AMA Guides Sixth 2021).

General criteria for Guides editorial changes

All past editorial change proposals satisfied each of the following criteria:

• The proposed editorial change was carefully drafted and conformed to the prevailing style of the AMA Guides
• The terminology and the analytical frameworks used in the proposal were consistent with the World Health Organization’s International Classification of Functioning, Disability, and Health (ICF)
• The structure and content of the proposed editorial change ensured that impairment ratings are transparent, clearly stated, and reproducible, to insure physician interrater reliability
• The clinical soundness of the proposed editorial change was demonstrated with the best available evidence except in the case of minor editorial changes (review the evidentiary requirements for additional information)

Evidentiary requirements

All updates to the AMA Guides were supported by an evidence-based foundation when possible. When evidence-based medicine was not available, consensus-based medicine developed in a structured Delphi approach may be substituted.

In order of preference, one of the following was required to support each proposed editorial change:

• Evidence-based medicine documented in peer reviewed articles published in medical journals indexed in PubMed, Web of Science, SCOPUS, or Google Scholar that are classified as Level of Evidence I-IV in the Oxford Centre for Evidence Based Medicine Level of Evidence Table (Appendix A)
• Outcomes-based Real-World Evidence (RWE), meaning observational data generated during routine clinical practice and stored in EHRs, medical claims or billing databases, and registries with evidence determined to be of High or Moderate quality using the WHO’s GRADE (Grading or Recommendations, Assessment, Development, and Evaluation) framework (Appendix B)
• Other peer-reviewed sources such as specialty society guidelines developed in accordance with the Institute of Medicine standards¹
• Consensus-based decisions developed in a Delphi process² endorsed or overseen by a relevant stakeholder professional association of society

In some cases, evidence may have taken the form of data or case law that demonstrates inconsistent application of the AMA Guides or a need for clarification of some element. In these cases, evidence of the need to enhance the AMA Guides may include judicial outcomes such as:

• State-based workers’ compensation impairment rating data that is categorized by CPT code or injury code
• Industrial Commissioner (or similar) data on litigated case outcomes when impairment ratings are an issue
• Judicial opinions or law journal articles that identify a specific issue of wide and inconsistent impairment ratings for similar conditions

Citations

¹ Institute of Medicine. 2011. Clinical Practice Guidelines We Can Trust. Washington, DC: The National Academies Press. https://doi.org/10.17226/13058

² Helmer-Hirschberg, Olaf, Analysis of the Future: The Delphi Method. Santa Monica, CA: RAND Corporation, 1967. https://www.rand.org/pubs/papers/P3558.html