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Medical necessity criteria updates to occur in fall 2025

The 2025-2026 Magellan Care Guidelines will become effective later this year. Stay tuned to our provider website, MagellanProvider.com, for the release. The 2024-2025 Magellan Care Guidelines will remain in effect until that time.

Magellan uses the MCG Behavioral Health Guidelines^® (“MCG”) in addition to Magellan’s proprietary clinical criteria (“Magellan Healthcare Guidelines”) as the primary decision support tools for its Utilization Management Program. 

Note that criteria for some levels of care, plans and states differ. Please visit our Medical Necessity Criteria webpage for more information.