Policy Updates Medical Policy & Clinical GuidelinesMedicaidFebruary 20, 2025

MCG Care Guidelines 29th edition

Effective June 1, 2025, Wellpoint will upgrade to the 29th edition of MCG Care Guidelines for the following modules. Below is high level summary of the updates and is not intended to be all inclusive:

  • Behavioral Health Care (BHG):
    • The guidelines for substance‑related disorders have been updated to allow users to identify ASAM citations more easily within MCG content. Benchmarks have been added to the guidelines for Applied Behavioral Analysis, Neuropsychological Testing, Psychological Testing, and Urine Toxicology Testing.
  • Inpatient & Surgical Care (ISC):
    • Five new observation care guidelines have been added. Also, a new mean arterial pressure (MAP) calculator has been added.
  • General Recovery Care (GRG):
    • A new Hospital‑at-Home General Recovery Guideline has been added.
  • Recovery Facility Care (RFC):
    • The discharge planning section for Inpatient Rehabilitation Facility guidelines was expanded.
  • Chronic Care (CCG):
    • New guidelines have been added to self‑management and low‑intensity disease management pediatric guidelines.

If you have questions, please contact Provider Services at 833‑731-2154.

Medicaid coverage provided by Wellpoint Tennessee, Inc.
We comply with the applicable federal and state civil rights laws, rules, and regulations and do not discriminate against members or participants in the provision of services on the basis of race, color, national origin, religion, sex, age, or disability. If a member or a participant needs language, communication, or disability assistance or to report a discrimination complaint, call 833-731-2154. Information about the civil rights laws can be found at tn.gov/tenncare/members-applicants/civil-rights-compliance.html.

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PUBLICATIONS: March 2025 Provider Newsletter