MedicaidMay 31, 2021
MCG Care Guidelines 25th Edition
Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.
Goal Length of Stay (GLOS) for Inpatient & Surgical Care (ISC)
Guideline |
MCG Code |
24th Edition GLOS |
25th Edition GLOS |
Aortic Coarctation, Angioplasty |
S-152 |
Ambulatory or 1 day postoperative |
Ambulatory |
Cardiac Septal Defect: Atrial, Transcatheter Closure |
W0016 |
Ambulatory or 1 day postoperative |
Ambulatory |
Esophageal Diverticulectomy, Endoscopic |
S-445 |
Ambulatory or 1 day postoperative |
Ambulatory |
Gastrectomy, Partial - Billroth I or II |
S-510 |
4 or 6 days postoperative |
5 days postoperative |
Hernia Repair (Non-Hiatal) |
S-1305 |
Ambulatory or 1 day postoperative |
Ambulatory |
Pancreatectomy |
S-1200 |
5 or 7 days postoperative |
6 days postoperative |
Pyloroplasty and Vagotomy |
S-990 |
4 or 6 days postoperative |
4 days postoperative |
Cervical Laminectomy |
W0097 |
2 days postoperative |
Ambulatory or 2 days postoperative |
Lumbar Diskectomy, Foraminotomy, or Laminotomy |
W0091 |
Ambulatory or 1 day postoperative |
Ambulatory |
Removal of Posterior Spinal Instrumentation |
S-530 |
1 day postoperative |
Ambulatory or 1 day postoperative |
Shoulder Hemiarthroplasty |
W0138 |
1 day postoperative |
Ambulatory or 1 day postoperative |
Spine, Scoliosis, Posterior Instrumentation, Pediatric |
W0156 |
4 days postoperative |
3 days postoperative |
Bladder Resection: Cystectomy with Urinary Diversion, Conduit or Continent |
S-190 |
5 or 6 days postoperative |
5 days postoperative |
Prostatectomy, Transurethral Resection (TURP) |
S-970 |
Ambulatory or 1 day postoperative |
Ambulatory |
Urethroplasty |
S-1172 |
Ambulatory or 1 day postoperative |
Ambulatory |
New Guidelines for Recovery Facility Care (RFC)
Body System |
Guideline Title |
MCG - Code |
Cardiology |
Hypertension |
M-5197 |
Cardiology |
Peripheral Vascular Disease (PVD) |
M-7087 |
Nephrology |
Rhabdomyolysis |
M-7095 |
Nephrology |
Encephalopathy |
M-7100 |
Thoracic Surgery |
Rib Fracture |
M-5545 |
To view a detailed summary of customizations click on this link, scroll down to other criteria section and select Customizations to MCG Care Guidelines 25th Edition.
For questions, please contact the Provider Services at 1-800-450-8753.
PUBLICATIONS: June 2021 Newsletter
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