Physician Health Partners performs medical management functions including the review of medical necessity. Physician Health Partners utilizes a hierarchy of criteria to include Medicare statutes and regulations (consisting of National Coverage Determination and Local Coverage Determination, Local Coverage Medical Policy Article, and the Medicare Benefit Policy Manual), UnitedHealthcare medical policies (to include Coverage Determination Guidelines, UnitedHealthcare Medical Benefit Drug Policies), UnitedHealthcare Medicare Part B Step Therapy Programs, and MCG Care Guidelines. Physician Health Partners does not utilize internal criteria to determine medical necessity. MCG Care Guidelines are the sole third-party guidelines utilized by Physician Health Partners to determine medical necessity.

MCG Guidelines are the protected intellectual property of MCG. Physician Health Partners is not able to distribute them without the permission of MCG. MCG has provided a tool that allows Physician Health Partners members and prospective members to view relevant MCG Guidelines, however you will not be able to print them.

Follow the instructions below for access to MCG Guidelines.

Access Instructions:

Step 1: Click Below button 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 view.