Clinical & Preventative Guidelines
Our Clinical and Preventive Guidelines assist clinicians by providing a framework for the evaluation and treatment of patients. These guidelines have not been developed as, nor should they be construed as absolute standards or minimal levels of care. The physician, in light of the individual circumstances presented by the patient, must make the ultimate judgment regarding the application of any specific mode of treatment. In other words, these guidelines are not intended to replace the clinical judgment of health care professionals.
Chorus Community Health Plan’s Medical Advisory Committee reviews the following guidelines at least every two years or earlier if there are significant evidence-based changes in best practices or updates to reference guidelines.
Immunization Schedule Guidelines
Other Guidelines
- Texas Department of Family and Protective Services
Guidelines for the Medication Utilization Parameters for Children and Adolescents (2016) - American Psychiatric Association (APA)
May, 2010- Practice Guideline for the Treatment of Patients with Major Depressive Disorder - US Preventative Services Task Force
US Department of Health and Human Services Guideline for the Diagnosis and Management of Asthma (2007) and Focused Update (2020) - American College of Obstetricians and Gynecologists (ACOG),
Available for purchase at: Clinical Guidelines for Prenatal Care (7th Edition)
Policies
- Continuous Passive Motion Devices
- Continuous Glucose Monitoring Devices
- CPAP-BPAP Use in OSA
- Custom Foot Orthotics
- Denosumab
- Drug Testing for Substance Use Disorders and Chronic Pain Treatment
- Enteral Nutrition
- Epidural Corticosteroid Injections for Spinal Pain
- Experimental, Investigational, or Unproven Medical Interventions
- Extended-Release Intra-Articular Glucocorticoids
- Facet Joint Injections
- Facet Neurotomy by Radiofrequency Ablation
- Gender-Affirming Medical and Surgical Services
- Genetic Testing
- Genicular Nerve Ablation
- Genicular Nerve Block
- Hearing Aids Wearable
- High Frequency Chest Wall Compression Devices
- Hyaluronic Acid Injections
- Implanted Electrical Spinal Cord Stimulators
- Infliximab
- Inpatient Approval for Elective Surgery
- Keloid Treatment and Scar Revision Surgery
- Knee Brace
- Lumbosacral Orthotics (Back Braces)
- Medical Necessity
- New Technologies
- Orthotic Compression Braces for Pectus Carinatum
- Out of Network
- Palivizumab
- Panniculectomy
- Personal Care Worker Services
- Replacement, Repair or Adjustments of DME
- Signatera and StrataNGS
- Scoliosis Back Braces Medical
- Sexually Transmitted Infection Testing
- Site of Service for Ambulatory Surgical Procedures
- Sphenopalatine Ganglion Block
- Supplemental Medical Necessity
- TENS
- Wound Vac