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
Allergen Immunotherapy
Asthma Guidelines
Pediatric Asthma Care Guidelines
Adult Asthma Care Guidelines
Behavioral Health Guidelines
American Academy of Child and Adolescent Psychiatry Practice Parameters
American Academy of Child and Adolescent Psychiatry - Practice Parameter for the Assessment and Treatment of Children and Adolescents With Attention-Deficit Hyperactivity Disorder.
American Academy of Child and Adolescent Psychiatry - Practice Parameter for the Assessment and Treatment of Children and Adolescents With Depressive Disorders
American Academy of Pediatrics Guidelines
American Academy of Pediatrics - ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.
American Society of Addiction Medicine Guideline
American Psychiatric Association Practice Guidelines
American Psychiatric Association - Practice guideline for the treatment of patients with major depressive disorder
DFPS/HHSC - Psychotropic Medication Utilization Parameters for Foster Children
Institute for Clinical Systems Improvement, Health Care Guideline: Major Depression in Adults in Primary Care
National Guideline Clearinghouse – Agency for Healthcare Research and Quality
Texas Administrative Code (TAC) §448.902 and Code of Federal Regulations (CFR) §8 for substance Use Disorder services.
State guidelines
The following are adult and child utilization management guidelines mandated by the state of Texas. These are recommended assessment guidelines and are foundational to the Texas Children’s Health Plan behavioral health program. Texas Children’s Health Plan will provide any of these resources in hard copy format upon request.
Child Texas Recommended Assessment Guidelines (TRAG)
Adult Texas Recommended Assessment Guidelines (TRAG)
Diabetes Guidelines
Diabetes Standards of Care
Diabetes Standards of Care Change Summary
Diabetes Care for Transition
Neuropsychology Guidelines
Neuropsychological Testing Guidelines
Otitis Guidelines
AAP Otitis Media with Effusion
Obesity Guidelines
NHLBI Obesity Guidelines for Adults
Pediatric Echocardiogram Guidelines
Pediatric Echocardiogram Guidelines
Training Guidelines for Pediatric Echocardiogram
Pharyngitis
Pharyngitis Practice Guidelines
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
Adult Immunization Schedule Narrative
Adult Immunization Schedule
Adult Preventative Services