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
Obesity Guidelines
National Heart, Lung, and Blood Institute (NHLBI) Obesity Guidelines for Adults
American Academy of Pediatrics
Endocrine Society
NIH Pediatric Obesity Algorithm
Opioid
Texas Vendor Drug Program Formulary - Opioids
Otitis Guidelines
The Diagnosis and Management of Acute Otitis Media
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
