Effective April 1, 2021, the following new customizations will be implemented:


  • Gastrointestinal bleeding, upper (W0170, previously ORG M-180) – Customized the clinical indications for admission to inpatient care by revising the hemoglobin; systolic blood pressure; pulse; melena; orthostatic hypotension; and BUN criteria.
  • Gastrointestinal bleeding, upper observation care (W0171, previously OCG OC-021) – Customized the clinical indications for observation care by revising the systolic blood pressure and hemoglobin criteria and adding melena or hematochezia and suspected history of bleeding.


To view a detailed summary of customizations, visit our website, scroll down to other criteria section and select Customizations to MCG Care Guidelines 24th Edition.


For questions, please contact the provider service number on the back of the member's ID card.




Featured In:
January 2021 Anthem Connecticut Provider News