Clinical Guidelines
Medicare Guidelines
Medi-Cal Guidelines
Health Plan Guidelines
Other Guidelines
MCG guidelines would only be used in the instance where there is no Medicare NCD or LCD/LCA or Health Plan policy addressing the requested service.
The clinical benefits of using this criteria are highly likely to outweigh any clinical harms, including from delayed or decreased access to services, because the criteria is unlikely to lead to circumstances where services are inappropriately denied.
MCG Guidelines
Conifer Health uses MCG Guidelines to help review medical necessity for health service requests. MCG Guidelines are the protected intellectual property of MCG. Conifer Health is not able to distribute them without the permission of MCG. MCG has provided a tool that allows Conifer Health members and prospective member to view relevant MCG guidelines, however you will not be able to print them.
Follow the instructions below for access
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.
Step 5: Click on the guidelines you wish to review.
