Clinical Practice Guidelines (CPGs) and Preventive Care Guidelines (PCGs) are adopted by Blue Cross and Blue Shield of Texas (BCBSTX) and are the foundation for selected Condition Management Programs. These guidelines are based on established evidence-based standards of care, publicized by specialty societies and national clinical organizations.

These guidelines are updated at least every 2 years, or when significant findings or major advancements in evidence-based practices and standards of care are established. These guidelines are current and have been reviewed and approved by the Clinical Quality Improvement Committee.

BCBSTX uses evidence-based clinical guidelines from nationally recognized sources to guide our quality and health management programs. Guidelines are designed to support the decision-making processes in patient care. Recommendations from other national entities may vary.

The Clinical Practice Guidelines (CPGs) are meant to serve as general guidelines and are not intended to substitute for clinical judgment in individual cases. At this time, BCBSTX endorses the American Academy of Family Physicians (AAFP) and American College of Physicians (ACP) criteria for defining high blood pressure, which varies from the values provided in other guidelines. Providers are encouraged to make decisions based on their own judgement and most current evidence-based information available. More detailed information regarding CPGs.

For more information, see our Quality Improvement (QI) Toolkit and Tip Sheets.

Resources

Reference and review the BCBSTX Preventive Care Guidelines (PCGs), Clinical Practice Guidelines (CPGs), and Texas Health Steps (THSteps) for Medical Providers, which includes all current vaccine schedules, ImmTrac2 and other important guidance for treating your patients.

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.

HEDIS is a registered trademark of NCQA. Use of this resource is subject to NCQA’s copyright, found here.