Modified Utilization Management Guidelines	Search the Modified UM Guidelines

BlueCross BlueShield of Tennessee alters Milliman Care Guidelines^® 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 the Milliman USA Milliman Care Guidelines^®. Milliman USA has neither reviewed nor approved the modified material. Any statement to the contrary or association of the modified material with Milliman USA is strictly prohibited. If you wish to view the complete Milliman Care Guidelines^®, please contact Milliman USA.

• 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
• Apnea, Apparent Life-Threatening Event
• Bladder Instillation for Treatment of Interstitial Cystitis
• Bone Excision
• Cesarean Section
• Deep Venous Thrombosis of Lower Extremities
• Gastric Restrictive Procedure with Gastric Bypass by Laparoscopy
• Laparoscopy, Surgical with Radical Hysterectomy
• Mastectomy, Modified Radical, with Insertion of Breast Prosthesis or Tissue Expander
• Patent Ductus Arteriosus, Thoracoscopic Closure
• Prostatectomy, Laparoscopic Radical
• Prostatectomy, Radical
• Prostatectomy, Transurethral Resection (TURP)
• Repair of Enterocele, Abdominal Approach
• Sacral Colpopexy, Abdominal Approach
• Shoulder Arthroplasty
• Shunt, Ventriculoperitoneal for Hydrocephalus
• Sling Operation for Correction of Male Urinary Incontinence
• Thoracic Surgery & Pulmonary Disease Intensive Care Admission
• Transcatheter Permanent Occlusion or Embolization
• Urethroplasty, Complex Reconstruction
• 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
Endocrinology	Ophthalmology
Evaluations & Modalities	Orthopedic
Gastroenterology	Otolaryngology
General Surgery	Pediatric
Genetic Medicine	Thoracic and Pulmonary
Hematology - Oncology	Urology
Musculoskeletal	Women's

Additional Listings:

Ambulatory Care

Home Care

Home Health (e.g., Skilled Nursing Visits)

Hospice Care

Inpatient and Surgical Care

Rehabilitative Care (e.g., Inpatient Rehabilitation)

Wound Care

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