Anthem Adopts MCG Care Guidelines

July 2018 ~

Anthem Blue Cross and Blue Shield’s (Anthem BCBS) has announced plans to replace its current behavioral health medical policies and clinical guidelines.

According to the insurer, effective with dates of service on and after October 31, Anthem BCBS and affiliate HealthKeepers, Inc. will begin using MCG Care Guidelines 22nd edition Behavioral Health guidelines for the review of behavioral health services.

The following behavioral health (BEH) coverage and clinical guidelines will be retained at this time:

  • BEH.00002 – Transcranial Magnetic Stimulation
  • BEH.00004 – Activity Therapy for Autism Spectrum Disorders and Rett Syndrome
  • CG-BEH-01 – Screening and Assessment for Autism Spectrum Disorders and Rett Syndrome
  • CG-BEH-02 – Adaptive Behavioral Treatment for Autism Spectrum Disorder
  • CG-BEH-14 – Intensive In-Home Behavioral Health Services

Anthem may continue to use additional coverage and clinical guidelines to supplement MCG Care Guidelines. For more information, refer to Anthem’s coverage and clinical guidelines. Customizations to MCG Care Guidelines 22nd edition can be seen, here.



Source(s): Anthem Blue Cross Blue Shield Network Update;