Special notice: Important policy changes

Mar. 2025Important Notices

Effective May 1, 2025, the following policies will be retired and replaced with prior authorization policies. For more information, please visit upmchp.us/policiesandprocedures.

  • Brachytherapy-MP.220 is being retired and will be replaced by Brachytherapy-MP.PA.139.
  • Implantable Loop Recorder (Subcutaneous) Cardiac Rhythm Monitor – MP.165 is being retired and will be replaced by Implantable Loop Recorder (Subcutaneous) Cardiac Rhythm Monitor – MP.PA.140.

  • Radiation Therapy, External Beam (EBRT) and Intensity-Modulated (IMRT) – MP.034 is being retired and will be replaced with Radiation Therapy, External Beam (EBRT) and Intensity-Modulated (IMRT) – MP.PA.142.

  • Radiation Therapy - SRS and SBRT – MP.060 is being retired and will be replaced with Radiation Therapy - SRS and SBRT – MP.PA.143.

  • Sleep Medicine – Sleep Study – MP.157 is being retired and will be replaced with Sleep Medicine – Sleep Study – MP.PA.144.

Again, prior authorization will be required for all of the new policies beginning May 1.

If you have any questions or concerns about these policy changes, please contact your physician account executive or call Provider Services at 1-866-918-1595.

Thank you for the excellent care and support you provide to our members.

Recent Announcements

Voluntary nationwide recall: Ocaliva (Intercept – September)

Intercept Pharmaceuticals, Inc. is voluntarily withdrawing Ocaliva® (obeticholic acid) from the market. Ocaliva is used to treat a rare liver disease called primary biliary cholangitis (PBC).
Oct. 2025Pharmacy Updates

HelpScript service helps patients enroll in manufacturer copay assistance programs

End-to-end provider support helps ensure a smooth submission process
Oct. 2025Important Notices

Important announcement – Telehealth submissions

As of October 1, 2025, UPMC Health Plan continues to accept the submission of telehealth claims. Providers may conduct telehealth visits for UPMC Health Plan members in all UPMC Insurance products. UPMC Insurance products include UPMC Advantage group and individual products, UPMC for Life Medicare Advantage plans, UPMC for Kids CHIP plans, UPMC Community HealthChoices, and UPMC for You Medical Assistance plans.
Sep. 2025Important Notices