Important update: Milliman Care Guideline (MCG), 23rd Edition; ORG: W0163 Pelvic Organ Prolapse Repair

Effective for dates of service on and after May 1, 2020, the updated clinical UM guideline MCG ORG: W0163 Pelvic Organ Prolapse Repair will now include the medical necessity review for pelvic organ prolapse repair surgery.

 

Initially, the clinical guideline only applied for pelvic organ prolapse length of stay review. With this update, it will also address the pre-operative and post-service medical necessity review of pelvic organ prolapse repair procedures. This change is effective for dates of service on and after May 1, 2020.

 

This notice does not apply to the Federal Employee Program® (FEP®), Medicare and Medicaid.