Effective for dates of service on and after May 1, 2020, the updated clinical UM guideline MCG ORG: W0163 Pelvic Organ Prolapse Repair will now include the medical necessity review for pelvic organ prolapse repair surgery.


Initially, the clinical guideline only applied for pelvic organ prolapse length of stay review. With this update it will also address the pre-operative and post-service medical necessity review of pelvic organ prolapse repair procedures. This change is effective for dates of service on and after May 1, 2020.


This notice does not apply to Federal Employee Program® (FEP®), Medicare and Medicaid.


* Notice of Material Changes/Amendments to Contract and Changes to Prior Authorization Requirements may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements.

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January 2020 Anthem Provider News - Missouri