The Information in This Exhibit Applies To the

The City of Fresno has implemented a Return-to-Work (RTW) program for those employees who have sustained an industrial injury while employed with the City. Our goal is to return employees to work as soon as they are medically able to do so and in accordance with their medical treatment plan. Early return to work can benefit an employee physically, psychologically and financially. Workplace rehabilitation has been found to speed up the recovery process while maintaining social contacts and productivity can promote psychological wellness. The RTW program will allow the employee to earn their regular pay, accrue and preserve their leave time and continue to receive City benefits such as health insurance and retirement contributions.

The City of Fresno may have the ability to accommodate the work restrictions of an employee and offer temporary modified or alternative work. We are asking for your assistance in this process. We will be focusing on the employee’s abilities rather than disabilities. In addition to restricted activity, we would appreciate knowing what tasks an employee can perform without adding further injury. This may be appropriate for employees who have been placed on Temporary Total Disability status. If you provide us with as much detail as possible on the work status report, we will be able to offer the best possible modified or alternative duties to ensure a smooth return to work transition.

The City of Fresno Authorized Primary and Secondary Providers must comply with the additional requirements as follows: 

Prior authorization items are items that do not require a DWC FORM RFA (request for authorization form and medical report).  The provider still needs to provide all mandatory and applicable required reports (DFR, PR2’s, narrative reports, work status forms, etc.) outlining pertinent items, including the patient’s diagnosis, treatment plan, outcomes achieved from the treatment provided, updated work status information, etc. The Prior Authorization listing applies to Authorized Treating Providers for The City of Fresno.


  • Initial x-rays
  • Initial Diagnostics (MRI, CT Scans, EMG/NCV, etc.) that the provider deems necessary for treatment planning purposes.  Repeat diagnostics require DWC RFA
  • Initial and routine DME that is under $250.00: splints, crutches, non-custom braces, slings, basic ice/gel/non-moist heating packs, manual wheelchairs for a 30 day rental
  • Basic 2 lead TENs Unit (only a basic 2 lead TENS unit) and up to 6 months of supplies
  • Lab work to establish baselines – Only the following labs have prior authorization: CBC, Chem/metabolic panel
  • Wound culture based on objective findings of infection (including a possible MRSA diagnosis)
  • Blood borne pathogen exposure panel (within 30 days from date of exposure)
  • HIV (antiretroviral only)/Hepatitis Agents within 30 days from date of verified industrial exposure
  • Oral non-narcotic medications deemed necessary for the industrial injury during the initial 45 days of the claim (excluding compound meds, topical compounded meds/medical foods) and that do not exceed $250.00 per prescription – Medications should not be dispensed from the office.  The injured worker has been enrolled in a Pharmacy Benefit Program and should present their prescription and PBM Card to a participating pharmacy
  • Narcotics up to initial 30 days (excluding long acting opioids/narcotics)
  • Antibiotics pre/post-operatively and post-traumatic open injury
  • Stool softeners deemed necessary due to other medication prescribed for the industrial injury
  • GERD Medications (when undergoing NSAID, high BP, antidepressant and/or Aspirin industrially related therapy
  • Physical or Occupational therapy up to 12 visits (pre-operatively) and up to 24 visits post operatively
    • Initial week of post-op home health RN or PT visits, when deemed appropriate by the treating provider, for those cases where the injured worker is not functionally able to participate in outpatient therapy (post hospital discharge)
  • Aquatic therapy up to 12 visits
  • Acupuncture up to 12 visits
  • Chiropractic up to 24 visits
  • Initial injections done in doctor’s office (up to 3)
    • Anything done in a Surgery Center and under fluoroscopy must be sent for UR (requires a DWC FORM RFA) – for example: ESI’s, transforaminal inj., etc.
  • Annual stress tests and echocardiograms for accepted cardiac claims

ALL EMERGENCY TREATMENT SHOULD BE PROVIDED AS APPROPRIATE AND NOT DELAYED TO OBTAIN PREAUTHORIZATION. In cases where the treating provider deems the treatment needed is emergent (life threatening, limb threatening, the absence of immediate medical treatment could place the health of the injured worker in serious jeopardy), the provider should provide the necessary treatment and then follow up to obtain retro authorization.