# AMA Guides 5th vs 6th Edition — Impairment Rating Comparison | IME Hub

> 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.

Canonical page: https://medrecords.ai/ime-hub/compare/ama5-vs-ama6/

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## 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.

## 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.

## Why it matters

The same clinical findings can produce different ratings across editions — the exact source of cross-examiner disputes.

## 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)

Last verified: 2026-08-15