Category: Medicaid


The upgrade to the 23rd edition of the MCG Care Guidelines for Anthem Blue Cross and Blue Shield Healthcare Solutions (Anthem) has changed from May 24, 2019, to October 18, 2019. In addition, Anthem has customized some of the MCG Criteria.


Customizations to the 23rd edition of the MCG Care Guidelines:


Effective October 18, 2019, the following customizations will be implemented:


  • Left Atrial Appendage Closure, Percutaneous (W0157) — customized to refer to SURG.00032 Transcatheter Closure of Patent Foramen Ovale and Left Atrial Appendage for Stroke Prevention

  • Spine, Scoliosis, Posterior Instrumentation, Pediatric (W0156) — customized to refer to Musculoskeletal Program Clinical Appropriateness Guidelines, Level of Care Guidelines and Preoperative Admission Guidelines


Effective November 1, 2019, customizations will be implanted for Chemotherapy and Inpatient & Surgical Care (W0162) for adult patients. The customizations provide specific criteria and guidance on the following:

  • Clinical indications for admission; examples will also be added for:
    • o Aggressive hydration needs that cannot be managed in an infusion center.
    • o Prolonged marrow suppression.
  • Regimens that cannot be managed outpatient; examples will also be added.


Providers can view a summary of the 23rd edition of the MCG Care Guidelines customizations online by selecting Customizations to MCG Care Guidelines 23rd Edition (Publish date November 1, 2019).


For questions, contact Provider Services at 1-844-396-2330.


ANV-NU-0071-19 August 2019

Featured In:
October 2019 Anthem Provider News and Important Updates - Nevada