Clinical Practice Guidelines

Below you will find all of the Clinical Practice Guidelines. If you wish to open the following forms, you must have Adobe Acrobat Reader installed on your computer. To download a form, right click on one of the links below and select "Save Target As."

To download a free copy of Adobe Acrobat Reader, click here.

Availability of Criteria

The criteria which is used to make an authorization decision is available to the practitioner over the phone or made available in our office for proprietary criteria. Criteria used from the public domain is facilitated through a URL link or a mailed copy.

Providers requesting the criteria by phone should call Provider Relations at 832-828-1004 and request the Utilization Review manager.

Allergy Guidelines

Allergy Diagnostic Testing: An Updated Practice Parameter
Allergen Immunotherapy

Asthma Guidelines

Global Initiative for Asthma (GINA) Guide for Management and Prevention
2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group | NHLBI, NIH
2020 Focused Updates to the Asthma Management Guidelines: Clinician's Guide | NHLBI, NIH
2020 Focused Updates to the Asthma Management Guidelines | NHLBI, NIH

Behavioral Health Guidelines

ADD/ADHD 

Clinical Practice Guideline: Diagnosis and Evaluation of the Child With Attention-Deficit/Hyperactivity Disorder | Pediatrics | American Academy of Pediatrics (aap.org)

Addiction Medicine

American Society of Addiction Medicine Clinical Guidelines
Texas Health and Human Services - Substance Abuse Outpatient Care

Anxiety

AACAP Clinical Practice Guideline - Anxiety

Behavioral Health Level of Care

American Academy of Child & Adolescent Psychiatry guidelines which include ECSII for children 0-5 and Calocus – CASII for 6-18

AACAP Clinical Practice Products

2016 American Association of Community Psychiatrists LOCUS guidelines

American Association of Community Psychiatrists Level of Care Utilization System for Psychiatric and Addiction Services Adult, Family of Tools

Depression

American Academy of Child and Adolescent Psychiatry Practice Parameters
AACAP Practice Parameter for the Assessment and Treatment of Children and Adolescents with Depressive Disorders
American Psychiatric Association Practice Guidelines
APA - Practice Guideline Major Depressive Disorder 
Institute for Clinical Systems Improvement, Health Care Guideline: Major Depression in Adults in Primary Care

State Guidelines – Screening and Drug Formulary

Texas Health and Human Services Child and Adolescent Needs and Strength Assessment (CANS) 
Texas Health and Human Services Adult Needs and Strength Assessment (ANSA)
Texas Health and Human Services Psychiatric Drug Formulary 

Diabetes Guidelines

Professional Practice Committee: Standards of Medical Care in Diabetes—2021 | Diabetes Care | American Diabetes Association (diabetesjournals.org)
Diabetes Standards of Care Change Summary 
Diabetes Care for Transition to Adult Diabetes Care Systems

Neuropsychology Guidelines

Neuropsychological Testing Guidelines

Otitis Guidelines

The Diagnosis and Management of Acute Otitis Media

Obesity Guidelines

National Heart, Lung, and Blood Institute (NHLBI) Obesity Guidelines for Adults
American Academy of Pediatrics
Endocrine Society
NIH Pediatric Obesity Algorithm

Syphilis Guidelines

Newborn

Congenital Syphilis

Maternal

See below, Syphilis testing and management in pregnancy

Pharyngitis Guidelines

Infectious Diseases Society of America Clinical Practice Guideline for Diagnosis and Management of Group A Streptococcal Pharyngitis

Prenatal and Postpartum Care Guidelines

Syphilis testing and management in pregnancy

State Health Advisory: New Syphilis Testing Requirements During Pregnancy In Effect 
Syphilis, HIV, and Hepatitis B Testing and Pregnancy: State Requirements for Texas Clinicians 
Guidelines for Perinatal Care, Eighth Edition, Chapter 6 Antepartum Care, Routine Laboratory Testing in Pregnancy

STD Screening

STD's During Pregnancy - CDC Detailed Fact Sheet
Guidelines for Perinatal Care, Eighth Edition, Chapter 6 Antepartum Care, Routine Laboratory Testing in Pregnancy

Reducing the Primary Cesarean Section Rate

Nation's OB/GYN's Take Aim at Preventing Cesareans
Avoidance of Non-medically Indicated Early-Term Deliveries and Associated Neonatal Morbidities
Cesarean Delivery on Maternal Request

Prenatal Care

Guidelines for Perinatal Care, Eighth Edition

Postpartum Care

Optimizing Postpartum Care
Postpartum Care of the New Mother

Maternal Substance Use/Abuse Screening and Management

Substance Abuse Reporting and Pregnancy: The Role of the Obstetrician–Gynecologist
Opioid Use and Opioid Use Disorder in Pregnancy
Marijuana Use During Pregnancy and Lactation
Alcohol Abuse and Other Substance Use Disorders: Ethical Issues in Obstetric and Gynecologic Practice
Tobacco and Nicotine Cessation During Pregnancy

Postpartum Depression Screening and Management

Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum
Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum

Maternal Morbidity and Mortality Prevention

Four in 5 pregnancy-related deaths in the U.S. are preventable
Eliminating Preventable Maternal Mortality and Morbidity
Maternal Mortality in the United States: Updates on Trends, Causes and Solutions
Maternal Death and Pregnancy-related Death; March of Dimes

Preventative Guidelines

Texas Health Steps Periodicity Schedule 
Recommended Immunization Schedule Age 0-18 
Catch-up Immunization Schedule Age 0-18 
AAP Bright Futures Periodicity Schedule 
Advisory Committee on Immunization Practices Recommended Immunization Schedule 2024
Adult Preventative Services 
Developmental Screening - Texas Children's Health Plan 

Tonsillectomy

Tonsillectomy in Children