Clinical Guidelines

To help provide our members with consistent, high-quality care that utilizes services and resources effectively, we have chosen certain clinical guidelines to help our providers. These are treatment protocols for specific conditions as well as preventive health guidelines.

These guidelines are intended to clarify standards and expectations. They should not:

Come before the provider's responsibility to treat a member based on their needs.
Substitute as orders for treatment of a member.
Guarantee coverage or payment for the type or level of care proposed by a provider.

We have adopted these guidelines for:

To learn more about the guidelines and to access helpful tool kits on treating various behavioral disorders, follow the links below:

Arizona opioid prescribing guidelines

Arizona Opioid Prescribing Guidelines

Clinical guidelines for the treatment of children

If you are a pediatrician or family medicine practitioner working with children, make sure you fully understand the Early Periodic Screening, Diagnosis and Treatment (EPSDT) Program and are familiar with the Childhood Immunization Schedule.

EPSDT Program: To help ensure children under age 18 get the screenings and preventive care they need, please refer to the EPSDT Periodicity Schedule.

Childhood Immunization Schedule

Well Visit Codes for EPSDT Members

Well-Visit Ages New Patients	CPT Codes	ICD-10 Codes	Well-Visit Ages Established Patients	CPT Codes	ICD-10 Codes
Infant (Younger than 1 Year)	99381	Z00.110 Z00.111 Z00.121 Z00129	Infant (Younger than 1 Year)	99391	Z00.110 Z00.111 Z00.121 Z00.129
1-4 Years	99382	Z00.121 Z00.129	1-4 Years	99392	Z00.121 Z00.129
5-11 Years	99383	Z00.121 Z00.129	5-11 Years	99393	Z00.121 Z00.129
12-17 Years	99384	Z00.121 Z00.129	12-17 Years	99394	Z00.121 Z00.129
18 Years or Older	99385	Z00.00 Z00.01	18 Years or Older	99395	Z00.00 Z00.01

For information on Immunizations, Codes to Identify Well-Child Visits, Screenings, Resources and Forms, Division of Developmental Disabilities, and Dental Care, refer to Mercy Care’ Provider Outreach Manual: EPSDT.
Websites below provide an extensive list of pediatric conditions and treatments
- http://www.childrenshospital.org/conditions-and-treatments#sort=%40fpagez32xtitle40686%20ascending
- https://www.chop.edu/conditions-diseases

For additional Clinical Practice Guidelines and comprehensive list of Preventative Screening tests please look here.

Clinical guidelines for the treatment of adults

As patients age, it remains important that we catch diseases as early as possible to be able to provide the best care that can lead to the best possible outcomes. Learn more about preventive and treatment guidelines for specific conditions in adults.

Adult immunization schedule: Don’t forget – kids aren’t the only ones who need immunizations. Make sure adult members are up-to-date on their influenza, Hepatitis A and B, MMR and other vaccines. For Immunizations, CDC Guidelines and additional Clinical Practice Guidelines, please look here.
Community-Acquired Pneumonia (CAP) Clinical: The CAP Clinical Guidelines is to develop an integrated approach to the outpatient management of CAP with an emphasis on prevention, early detection and patient education. View guidelines from the Infectious Diseases Society of America website and American Thoracic Society Consensus.
HIV guidelines: Mercy Care advises providers to refer to the guidelines and resources provided by the National Institutes of Health on its website.

For a comprehensive list of Preventative Screening tests please look here.

Treating behavioral health disorders in children

If you are treating children with behavioral health disorders, Mercy Care offers a variety of resources related to anxiety, depression, ADHD, and children with special needs.

For the AHCCCS Behavioral Health System Practice Tools: Working with Birth Through Five Population Practice Tool, please look here.
For Clinical Practice Guidelines on ADHD, please look here.
This website provides helpful resources and trainings for families already providing or considering foster care or adoption
- http://www.aask-az.org/
Websites below provide helpful resources for families raising a special needs kids and the referral guidance to a healthcare professionals:

Treating behavioral health disorders in adults

The following resources are intended to help healthcare providers to screen, diagnose and treat behavior health disorders in adults.

Click each link for the Clinical Practice Guidelines on: