Modified Utilization Management Guidelines	Search the Modified UM Guidelines

BlueCross BlueShield of Tennessee alters MCG™ when guidelines do not exist for certain conditions, when length of stay needs to be defined, or when consideration is given to prevailing practice in a specific area. The BCBST Modified Utilization Management Guidelines are reviewed annually or if an inquiry is received.

The following guidelines have been revised from MCG™. MCG Health, LLC has neither reviewed nor approved the modified material. Any statement to the contrary or association of the modified material with MCG Health, LLC is strictly prohibited. If you wish to view the complete MCG™, please contact MCG Health, LLC.

• Modified UM Guideline Appeals Process
• Upcoming Modifications to UM Guidelines
• Search the Modified UM Guidelines

Modified UM Guidelines:

Goal Length of Stay Modifications (e.g., ambulatory goal length of stay changed to 23-hr observation)

• Ambulatory Goal Length of Stay
• Ambulatory or 1 & 1-day Goal Length of Stay
• Ambulatory or 2 & 1 or 2 days Goal Length of Stay
• Ambulatory Surgery Complications
• Ambulatory/Day Surgery Criteria
• Bladder Instillation for Treatment of Interstitial Cystitis
• Bone Excision
• Cesarean Delivery
• Gastric Restrictive Procedure with Gastric Bypass by Laparoscopy
• Ileus
• Intestinal Obstruction
• Knee Arthroplasty
• Laparoscopy, Surgical with Radical Hysterectomy
• Mastectomy, Complete, with Insertion of Breast Prosthesis or Tissue Expander
• Prostatectomy, Laparoscopic Radical
• Prostatectomy, Radical
• Shoulder Arthroplasty
• Shunt, Ventriculoperitoneal for Hydrocephalus
• Thoracic Surgery and/or Pulmonary Disease Intensive Care Admission
• Transcatheter Permanent Occlusion or Embolization
• Vaginal Delivery
• Vaginal Delivery, Operative

Listed Alphabetically:

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z (view entire list)

Listed by Conditions:

Cardiology	Neurology
Cardiovascular Surgery	Neurosurgery
Durable Medical Equipment	Obstetrics and Gynecology
Ear, Nose, and Throat	Ophthalmology
Endocrinology	Orthopedic
Evaluations & Modalities	Otolaryngology
Gastroenterology	Pediatric
General Surgery	Thoracic and Pulmonary
Genetic Medicine	Urology
Hematology - Oncology	Women's
Musculoskeletal

Additional Listings:

Ambulatory Care

Home Care

Home Health (e.g., PDN calculators)

Hospice Care

Inpatient and Surgical Care

Rehabilitative Care (e.g., Inpatient Rehabilitation)

This document has been classified as public information.