Policy Updates Medical Policy & Clinical GuidelinesMedicare AdvantageFebruary 20, 2025

MCG Care Guidelines 29th edition

Effective June 1, 2025, Anthem will upgrade to the 29th edition of MCG Care Guidelines for the following modules. Below is high level summary of the updates and is not intended to be all inclusive:

  • Behavioral Health Care (BHG):
    • The guidelines for substance‑related disorders have been updated to allow users to identify ASAM citations more easily within MCG content. Benchmarks have been added to the guidelines for Applied Behavioral Analysis, Neuropsychological Testing, Psychological Testing, and Urine Toxicology Testing.
  • Inpatient & Surgical Care (ISC):
    • Five new observation care guidelines have been added. Also, a new mean arterial pressure (MAP) calculator has been added.
  • General Recovery Care (GRG):
    • A new Hospital‑at-Home General Recovery Guideline has been added.
  • Chronic Care (CCG):
    • New guidelines have been added to self‑management and low‑intensity disease management pediatric guidelines.

If you have questions, please contact Provider Services via the number on the back of our member ID card.

In Missouri (excluding 30 counties in the Kansas City area): Anthem Blue Cross and Blue Shield is the trade name of RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

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PUBLICATIONS: March 2025 Provider Newsletter