Member Clinical Guidelines

Magellan uses MCG Care Guidelines for Behavioral Health®, The American Society of Addiction Medicine (ASAM) Criteria® and Magellan Care Guidelines to help review medical necessity requests for behavioral health services covered by your Plan. Click on the following link to review the current version of Magellan Care Guidelines: www.MagellanProvider.com/MNC.

For Medicare beneficiaries, Magellan Healthcare use guidelines and policies from the Centers for Medicare and Medicaid Services (CMS) to make clinical decisions. When CMS policies are not available, Magellan Healthcare may make coverage decisions using MCG Health clinical guidelines.

MCG Care Guidelines for Behavioral Health® are the protected intellectual property of MCG. Magellan is not able to distribute them without the permission of MCG. MCG has provided a tool that allows Magellan members and providers to view relevant MCG Care Guidelines.

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

Access Instructions

Step 1: Click here to access the MCG Guidelines, read the disclaimer and accept the terms and conditions.
Step 2: Complete the User Information form.
Step 3: Complete the verification process to continue.
Step 4: Click on the arrow icon next to Behavioral Health Care Guidelines to view.
Step 5: Click on the guidelines you wish to view. Copy/pasting, printing or other methods of duplication are not allowed.
Step 6: Once finished, close the tab.

The ASAM Criteria®: Treatment Criteria for Addictive, Substance-Related and Co-Occurring Conditions is used to review requests for substance use treatment.

• Here’s a summary of The ASAM Criteria®:
  The ASAM Criteria for Patients and Families (PDF)

If you have any issues please email:
MCGGuidelinesRequest@MagellanHealth.com