# AMA Guides Editions Explained — 4th, 5th and 6th > Every AMA Guides edition from 4th (1993) to 6th (2008, 2023/2025 updates): what changed, which states use what, and why the edition determines the rating. Canonical page: https://medrecords.ai/content-hub/guides/ama-guides-editions/ --- [Content Hub](https://medrecords.ai/content-hub/) › Guides ## AMA Guides Editions Explained — 4th, 5th, 6th, and the 2023/2025 Updates The AMA Guides to the Evaluation of Permanent Impairment is the standard treatise for impairment rating, and the edition a state adopts determines the method — California uses the 5th, Pennsylvania and Tennessee use the 6th, and the 2023/2025 digital updates revised the musculoskeletal and nervous-system chapters. 5 sections·5 sources·Verified 2026-08-15 ✓ 01 ### Edition timeline Edition timeline — 4 editions in circulation 1993 4th Edition Still in use in some jurisdictions, and by New Zealand’s ACC through the User Handbook to AMA4. 2000 5th Edition California’s standard under Labor Code § 4660(b)(1). Diagnosis-based, with the DRE and ROM spine methods. 2008 6th Edition Impairment classes and grades, whole-person calculation, functional focus aligned with the WHO ICF. Pennsylvania adopted the 2nd printing (2009); Tennessee and Montana followed. 2023 – 2025 Digital updates to the 6th Revised upper limb, lower limb, spine and nervous-system content. Training offered by ACOEM and the AMA. 4 editions are still live somewhere in North America at once, which is why the edition question has to be answered per jurisdiction before a rating is worth anything. The marked entry is the current revision of the most recently published edition. - **4th Edition (1993):** still used in some jurisdictions and by New Zealand's ACC (User Handbook to AMA4) - **5th Edition (2000):** California's standard under LC 4660(b)(1); taught through courses like AAMVI's 5th Edition Impairment Rating - **6th Edition (2008):** standardized methodology; adopted by PA (2nd printing 2009), TN, MT and others - **6th 2023 / 2025 updates:** revised upper limb, lower limb, spine, and nervous system content; training offered by ACOEM and AMA 02 ### 5th vs 6th — the real difference The 6th replaced much of the 5th's diagnosis-based approach with impairment classes and grades, a consistent whole-person impairment calculation, and a stronger functional focus aligned with the WHO ICF. The DRE vs ROM distinction remains central to spine rating in both. 03 ### Which states use what 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/) Verify the edition per state before rating — this is the highest-error-risk fact in impairment rating. Of the 10 jurisdictions 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. California: 5th. Pennsylvania: 6th (2nd printing 2009). Tennessee: 6th (approved training). Montana: 6th statutory. Florida: its own 1996 schedule. New York: its own SLU guidelines. Texas: commissioner-adopted edition. **Always verify the current edition per state — this is the highest-error-risk fact in impairment rating.** 04 ### The companion treatises - AMA Guides to the Evaluation of Disease and Injury Causation (2nd ed., 2014): work-relatedness, methodology, apportionment, report writing - AMA Guide to the Evaluation of Functional Ability: requesting and interpreting FCEs - AMA Guides to the Evaluation of Work Ability and Return to Work 05 ### Training landscape AMA Guides training platforms offer ~200 modules; ACOEM and state-approved providers (TN list) offer edition-specific courses; ABIME CIME and AADEP CEDIR certify the examiners. This hub maps those courses to free guides. ### Sources - [AMA Guides Digital](https://ama-guides.ama-assn.org/) - [AMA Guides training resources](https://www.ama-assn.org/practice-management/ama-guides/ama-guides-training-resources) - [CA Labor Code 4660](https://law.justia.com/codes/california/2020/code-lab/division-4/part-2/chapter-2/article-3/section-4660/) - [34 Pa. Code 123.105](https://regulations.justia.com/states/pennsylvania/title-34/part-viii/chapter-123/subchapter-b/section-123-105/) - [ACC User Handbook to AMA4](https://www.acc.co.nz/assets/provider/ama4-handbook-acc716.pdf) 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-ama-guides-editions) [Book a demo](https://medrecords.ai/demo/?src=content-hub-ama-guides-editions) ### How Medrecords AI does this work Medrecords AI does this category of work as software. The record is sorted, deduplicated and read in minutes, every statement cited back to its page, and a qualified human signs off on what it means. [Solution — **IME & medical-legal** — Referral packets prepped and cited before the physician opens them. Read more →](https://medrecords.ai/solutions/ime/?src=content-hub-ama-guides-editions) [Product — **IME report drafting** — Dictation and record turned into a template-complete draft for the examiner. Read more →](https://medrecords.ai/product/ime-report-drafting/?src=content-hub-ama-guides-editions) [Product — **Medical chronology** — A dated, deduplicated timeline with a citation on every entry. Read more →](https://medrecords.ai/product/chronology/?src=content-hub-ama-guides-editions) 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-ama-guides-editions) [Book a demo](https://medrecords.ai/demo/?src=content-hub-ama-guides-editions) ### 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-ama-guides-editions) [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