# 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.

Canonical page: https://medrecords.ai/ime-hub/guides/ama-guides-editions/

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## Edition timeline

- **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

## 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.

## Which states use what

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.**

## 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

## 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)

Last verified: 2026-08-15