New MCG Care Guidelines 24th edition

This communication applies to the Medicaid, Medicare Advantage and Medicare-Medicaid Plan (MMP) programs for Anthem Blue Cross (Anthem).

Effective August 1, 2020, Anthem will use the new acute viral illness guidelines that have been added to the 24th edition of the MCG Care Guidelines. Based on the presenting symptoms or required interventions driving the need for treatment or hospitalization, these guidelines are not a substantive or material change to the existing MCG Care Guidelines we use now, such as systemic or infectious condition, pulmonary disease, or adult or pediatric pneumonia guidelines.

Inpatient Surgical Care (ISC):

• Viral Illness, Acute — Inpatient Adult (M-280)
• Viral Illness, Acute — Inpatient Pediatric (P-280)
• Viral Illness, Acute — Observation Care (OC-064)

 

Recovery Facility Care (RFC):

 

• Viral Illness, Acute — Recovery Facility Care (M-5280)

 

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