Clinical Practice Guidelines

Clinical Practice Guidelines for Texas Commercial, Marketplace, Medicare and Medicaid plans

Clinical Practice Guidelines (CPGs) and Preventive Care Guidelines 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 and when new 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 BCBSTX Clinical Quality Committee. If you have any questions about the guidelines, or wish to provide feedback, this can be done by contacting the Quality Improvement Department at 1-800-863-9798 or by email.

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. The links below provide information about the CPGs:

Note: Some of the material is copyrighted and has been used by permission:

Asthma — Guidelines for Diagnosis and Management

Cardiovascular Disease Guidelines 

Chronic Kidney Disease Guidelines 

COPD & Diagnosis Management and Prevention 

Diabetes Mellitus – Standards of Care 

Heart Failure Guidelines 

HIV Clinical Practice Guidelines

Hypertension Guidelines 

Metabolic Syndrome Guidelines 

Sleep Apnea Guidelines 

Tobacco Cessation Guidelines 

Weight Management