Policy UpdatesMedicaid Managed CareMay 2, 2023

MCG Care Guidelines 27th edition

Effective September 1, 2023, we will upgrade to the 27th edition of MCG Care Guidelines for the following modules:

  • Inpatient & Surgical Care (ISC)
  • General Recovery Care (GRG)
  • Recovery Facility Care (RFC)
  • Behavioral Health Care (BHG)
  • Chronic Care (CCG)
  • Home Care (HC)
  • Ambulatory Care (AC)

The below tables highlight new guidelines and changes. Updates marked with an asterisk (*) notate that the criteria may be perceived as more restrictive.

Goal Length of Stay (GLOS) for Inpatient & Surgical Care (ISC)

Guideline

MCG code

26th edition GLOS

27th edition GLOS

*Electrophysiologic Study and Implantable Cardioverter-Defibrillator (ICD) Insertion

M-157

Ambulatory or 1 day postoperative

Ambulatory

*Renal Failure, Acute

M-326

3 days

2 days

*Paraplegia, Acute

M-255

8 days

7 days

*Tetraplegia, Acute

M-305

9 days

7 days

*Percutaneous Revascularization, Lower Extremity

S-1310

Ambulatory or 1 day postoperative

Ambulatory

*Splenectomy by Laparoscopy

S-1062

1 day postoperative

Ambulatory or 1 day postoperative

*Elbow Arthroplasty

S-420

Ambulatory or 1 day postoperative

Ambulatory

*Elbow Fracture, Open Treatment

S-424

Ambulatory or 1 day postoperative

Ambulatory

*Foot Fracture, Calcaneus or Talus, Open Reduction, Internal Fixation (ORIF)

S-490

Ambulatory or 1 day postoperative

Ambulatory

*Foot: Surgical Wound Care

S-495

Ambulatory or 1 day postoperative

Ambulatory

*Hip Resurfacing

S-565

2 days postoperative

Ambulatory or 1 day postoperative

*Knee Dislocation, Closed or Open Reduction

S-675

Ambulatory or 1 day postoperative

Ambulatory

*Shoulder Arthroplasty

S-634

1 day postoperative

Ambulatory or 1 day postoperative

*Appendectomy, without Abscess or Peritonitis, Pediatric

P-25

Ambulatory or 1 day postoperative

Ambulatory

*Hip: Congenital Dislocation, Open Reduction

P-590

1 day postoperative

Ambulatory or 1 day postoperative

*Renal Transplant, Pediatric

P-1015

6 days postoperative

5 days postoperative

*Slipped Upper Femoral Epiphysis, Closed Reduction

P-443

Ambulatory or 1 day postoperative

Ambulatory

*Tibial Osteotomy, Child or Adolescent

S-1131

Ambulatory or 1 day postoperative

Ambulatory

*Bladder Incision: Cystotomy

S-200

Ambulatory or 1 day postoperative

Ambulatory

*Ureterotomy, Nontransurethral for Stone

S-1150

1 day postoperative

Ambulatory or 1 day postoperative

New Guidelines for Inpatient & Surgical Care (ISC)

Body System

Guideline Title

MCG - Code

Hospital-at-Home

COVID-19: Hospital-at-Home

M-281-HaH

Hospital-at-Home

Viral Illness, Acute: Hospital-at-Home

M-280-HaH

Observation Care Guidelines

COVID-19: Observation Care

OC-068

Pediatrics

COVID-19, Pediatric

P-281

Thoracic Surgery and Pulmonary Disease

COVID-19

M-281

New Guidelines for Recovery Facility Care (RFC)

Body System

Guideline Title

MCG - Code

Cardiovascular Surgery

Percutaneous Revascularization, Lower Extremity

S-6310

Thoracic Surgery and Pulmonary Disease

COVID-19

M-5281

New Guidelines for Chronic Care (CCG)

Body System

Guideline Title

MCG - Code

Social Determinants of Health

Food Insecurity

C-1164

Social Determinants of Health

Housing Insecurity

C-1165

New Guidelines for Home Care (HC)

Body System

Guideline Title

MCG - Code

Cardiovascular Surgery

Percutaneous Revascularization, Lower Extremity

S-3310

Thoracic Surgery and Pulmonary Disease

COVID-19

M-2281

New Guidelines for Ambulatory Care (AC)

Body System

Group

Guideline Title

MCG - Code

Genetic Medicine

Oncology

Oncology Companion Diagnostic Testing -FoundationOne CDx

A-1055

Genetic Medicine

Oncology

Oncology Companion Diagnostic Testing -Guardant360 CDx

A-1056

Procedures and Diagnostic Tests

Neurology

EEG, Quantitative (Brain Mapping)

A-1050

Procedures and Diagnostic Tests

Orthopedics

Neurolysis, Genicular Nerve

A-1047

Procedures and Diagnostic Tests

Orthopedics

Sacroiliac Joint Injection

A-1048

Procedures and Diagnostic Tests

Thoracic Surgery and Pulmonary Disease

Endobronchial Ultrasound

A-1049

Specialty Medications

Eye Conditions

Faricimab-svoa

A-1051

Specialty Medications

Hematologic Conditions

Betibeglogene Autotemcel

A-1057

Specialty Medications

Oncologic Conditions

Ciltacabtagene Autoleucel

A-1052

Specialty Medications

Pulmonary Conditions

Tezepelumab-ekko

A-1053

If you have questions, please contact the Provider Service number on the back of the member's ID card.

OHBCBS-CD-021789-23-CPN20908

PUBLICATIONS: June 2023 Provider Newsletter