HMSA

Magellan uses MCG Care Guidelines, along with our proprietary clinical criteria, Magellan Healthcare Guidelines, as the primary decision support tools for our Utilization Management Program. Collectively, they are known as the Magellan Care Guidelines.

All guidelines meet federal, state, industry accreditation, and customer contract requirements. They are based on sound scientific evidence for recognized settings of behavioral health services and are designed to decide the medical necessity and clinical appropriateness of services. Note: Magellan does not manage autism services for HMSA members.

Effective Jan. 1, 2026

The 2025-2026 Magellan Care Guidelines (PDF) include:

• Magellan Healthcare Guidelines -- These are publicly available at the link above.
• MCG Care Guidelines -- These guidelines are proprietary to MCG Health; to view a copy of a guideline associated with a member’s clinical review, contact Magellan at the number on the member’s benefit card, and a representative will send you a copy or grant you special online access.
• The ASAM Criteria®, 3rd edition: see below.

Review a summary of changes (PDF) to the 2025-2026 Magellan Care 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)

Providers may obtain the criteria directly from ASAM.

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