Clinical Guideline Criteria

Need to review a care guideline but you don't have a guideline code? If you do not have a guideline code, you can search the whole list of MCG Care Guidelines.

Blue Cross and Blue Shield of Texas (BCBSTX) uses MCG Care Guidelines to help review the medical necessity of requests covered by Medicare Advantage Plans. MCG Guidelines are proprietary and BCBSTX is not able to distribute them without MCG's permission. MCG has provided a tool that allows BCBSTX members to view the relevant MCG Guidelines.

By following these instructions, you can access the MCG Care Guidelines on your web browser, but will not be able to print them.

  • Go to this MCG Care Guidelines website.
  • Accept the terms and conditions.
  • Enter your name.
  • Choose either “Existing Member of the Health Plan” if you are currently a member or “Prospective Member of the Health Plan” if you are not yet a member.
  • Enter your contact information and the access code sent to you, then select the guideline.