# AMA Guides 5th vs 6th Edition — Compared | Content Hub > AMA Guides 5th vs 6th Edition: methodology changes, state adoption, and why the edition determines the rating. Verified 2026-08-15. Canonical page: https://medrecords.ai/content-hub/compare/ama5-vs-ama6/ --- [Content Hub](https://medrecords.ai/content-hub/) › Compare ## AMA Guides 5th vs 6th Edition — Impairment Rating Comparison The AMA Guides 6th Edition changed impairment rating from the 5th's diagnosis-based approach toward a more standardized, diagnosis-plus-functional-loss model — and which edition applies depends entirely on the state. 3 sections·4 sources·Verified 2026-08-15 ✓ 01 ### What changed in the 6th The 6th introduced a consistent impairment-class and grade framework, whole-person impairment calculation, and stronger functional focus. The 2024/2025 digital updates revised the musculoskeletal and nervous-system chapters — training is offered by ACOEM and others. 02 ### State adoption California uses the 5th (Labor Code 4660). Pennsylvania requires the 6th (2nd printing 2009). Tennessee's approved training list mandates 6th Edition training. Florida uses its own schedule. Verify the edition per state before rating. 03 ### Why it matters The same clinical findings can produce different ratings across editions — the exact source of cross-examiner disputes. Rating basis by jurisdiction — 10 states profiled [California — QME — Labor Code § 4660(b)(1) — **AMA Guides 5th** ](https://medrecords.ai/content-hub/states/ca/) [Pennsylvania — IRE — 34 Pa. Code § 123.105; Act 142 — **AMA Guides 6th** ](https://medrecords.ai/content-hub/states/pa/) [Tennessee — IR training — State-approved training list — **AMA Guides 6th** ](https://medrecords.ai/content-hub/states/tn/) [Colorado — DIME — Rule 11 — **Edition set by agency** ](https://medrecords.ai/content-hub/states/co/) [Ohio — IME / DME — BWC policy — **Edition set by agency** ](https://medrecords.ai/content-hub/states/oh/) [Texas — Designated Doctor — 28 TAC 130.1 — **Edition set by agency** ](https://medrecords.ai/content-hub/states/tx/) [Washington — IME — L&I Medical Examiners' Handbook — **Edition set by agency** ](https://medrecords.ai/content-hub/states/wa/) [Florida — IRE / Schedule — 1996 Florida Impairment Rating Schedule — **State schedule, not AMA** ](https://medrecords.ai/content-hub/states/fl/) [New York — IME / SLU — 2018 SLU guidelines — **State schedule, not AMA** ](https://medrecords.ai/content-hub/states/ny/) [Arizona — DME — No canonical state source verified — **Not confirmed** ](https://medrecords.ai/content-hub/states/az/) Which edition applies is a jurisdictional fact, not a physician preference. Of the 10 states profiled in this hub, **1** works to the 5th, **2** require the 6th, **4** leave the edition to the agency, and **2** use their own schedule instead of the AMA Guides at all. ### Key facts | 5th Edition (2000) | California standard (LC 4660); DRE/ROM spine methods; diagnosis-based | | --- | --- | | 6th Edition (2008/2023) | Pennsylvania, Tennessee, Montana and others; standardized methodology aligned with ICF | | 2023/2025 updates | Musculoskeletal chapters (upper limb, lower limb, spine) and nervous system updated | | Key takeaway | Edition choice is jurisdictional, not physician preference | ### Sources - [AMA Guides Digital](https://ama-guides.ama-assn.org/) - [California Labor Code 4660](https://law.justia.com/codes/california/2020/code-lab/division-4/part-2/chapter-2/article-3/section-4660/) - [Tennessee approved training](https://www.ext.glb.mytn.gov/content/tn/workforce/injuries-at-work/bureau-services/bureau-services/medical-programs-redirect/assistance-for-medical-providers/approved-medical-impairment-rating-training.html) - [ACOEM AMA Guides 2024 updates course](https://connect.acoem.org/CPBase__item?id=a13Uu00000Qc907IAB) Medrecords AI Every line cited back to its page. Send one real record set. We return a cited chronology you can check line by line, and a human decides what it means. [Test on a file](https://medrecords.ai/test-a-file/?src=content-hub-ama5-vs-ama6) [Book a demo](https://medrecords.ai/demo/?src=content-hub-ama5-vs-ama6) ### How Medrecords AI does this work Medrecords AI reads the same records these platforms handle. The difference is what comes back: a sorted, deduplicated file with a citation on every line, and a human deciding what it means. Judge it against the comparison above. [Solution — **Medical record review** — The review you were about to outsource, delivered as software — every line cited. Read more →](https://medrecords.ai/solutions/medical-record-review/?src=content-hub-ama5-vs-ama6) [Product — **Medical chronology** — A dated, deduplicated timeline with a citation on every entry. Read more →](https://medrecords.ai/product/chronology/?src=content-hub-ama5-vs-ama6) [Product — **Citations** — Every statement links back to the page and line it came from. Read more →](https://medrecords.ai/product/citations/?src=content-hub-ama5-vs-ama6) Test it on a file you already have. Send one real record set. You get back a cited chronology and decide for yourself whether the read holds up — no obligation either way. [Test a file](https://medrecords.ai/test-a-file/?src=content-hub-ama5-vs-ama6) [Book a demo](https://medrecords.ai/demo/?src=content-hub-ama5-vs-ama6) ### Explore the Content Hub [ #### Software & platforms AI and case-management platforms across medical-record review. ](https://medrecords.ai/content-hub/software/) [ #### Service providers & BPOs IME, peer review, retrieval, and BPO providers. ](https://medrecords.ai/content-hub/services/) [ #### State programs Rules, AMA Guides edition, and MMI standards by state. ](https://medrecords.ai/content-hub/states/) [ #### Comparisons Head-to-head vendor and program comparisons. ](https://medrecords.ai/content-hub/compare/) [ #### Guides Editorial reference on report writing, MMI, and validity testing. ](https://medrecords.ai/content-hub/guides/) [ #### Conferences & events Workers' comp, claims, and IME conferences with editorial takes. ](https://medrecords.ai/content-hub/events/) [ #### Directories Link-out rosters of examiners, LNCs, and expert witnesses. ](https://medrecords.ai/content-hub/directory/) [ #### State matrix report All 10 verified state programs, side by side. ](https://medrecords.ai/content-hub/reports/ime-state-matrix-2026/) [ #### Content Hub home The full index of everything in the hub. ](https://medrecords.ai/content-hub/) Medrecords AI ### Minutes per file. Every line cited. 10¢ a page. Bring the hardest file from this page. Get a cited chronology and a report draft in minutes — every line traced to its source page, ready for your review and signature. - Minutes per file, not days - Every line cited to its source page - Flat 10¢/page, duplicates free — no license, no minimums - HIPAA-eligible · SOC 2 audit-ready [Test on a file](https://medrecords.ai/test-a-file/?src=content-hub-ama5-vs-ama6) [Book a demo](https://medrecords.ai/demo/) See how Medrecords AI compares with anything on this page — over a 30-minute call, side by side. Last verified: 2026-08-15