State & FederalMedicaidAugust 31, 2019

MCG Care Guidelines update and customizations

Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.

Category: Medicaid

The upgrade to the 23rd edition of the MCG Care Guidelines for Empire BlueCross BlueShield HealthPlus (Empire) has changed from May 24, 2019, to September 5, 2019. In addition, Empire has customized some of the MCG Criteria.

 

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

Effective September 5, 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 implemented for Chemotherapy and Inpatient & Surgical Care (W0162) for adult patients. The customizations provide specific criteria, guidance and/or examples for the following:

  • Clinical indications for admission:
    • Aggressive hydration needs that cannot be managed in an infusion center
    • Prolonged marrow suppression
  • Regimens that cannot be managed outpatient

 

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 1-800-450-8753.

 

NYE-NU-0154-19 August 2019

PUBLICATIONS: September 2019 Empire Provider News