Anthem customizations to MCG Care Guidelines, 24th Edition

Effective July 1, 2020, the following MCG care guideline 24th edition customizations will be implemented:

 

• Carotid Artery Stenting (W0165) – Clinical Indications were customized to reference CG-SURG-76 Carotid, Vertebral and Intracranial Artery Stent Placement with or without Angioplasty

 

• Deep Brain Stimulation (W0164) – Clinical Indications were customized to refer to SURG.00026 Deep Brain, Cortical, and Cerebellar Stimulation.

 

• Vagus Nerve Stimulation, Implantable (W0166) – Clinical Indications were customized to refer to SURG.00007 Vagus Nerve Stimulation.

 

View a detailed summary of the MCG customizations and scroll down to other criteria section.  Select Customizations to MCG Care Guidelines 24th Edition .

For questions, please contact the provider service number on the back of the member's ID card.