Understanding MP.PA.147

Jul. 2025Important Notices

Understanding changes to the Diagnostic and Surveillance Colonoscopy, 18 Years Old and Older – MP.PA.147 policy

Effective date July 1, 2025 , the Diagnostic and Surveillance Colonoscopy, 18 Years Old and Older – MP.PA.147 policy contains clarifications in key areas:

Prior authorizations. As of July 1, 2025 MP.PA.147 now requires prior authorization for many codes across all lines of business. It is important to note that this policy applies only to diagnostic and surveillance colonoscopies, as screening exams are outside the scope of MP.PA.147.

Billing. MP.PA.147’s coding section clarifies how providers must bill the codes to denote a screening exam. The provider is responsible for clinical decisions and billing. For information on using modifier 33 and modifier PT for screening colonoscopies, please review the Colorectal Cancer Screening Billing Guide.

Learn more about MP.PA.147

Review the complete MP.PA.147 bulletin

Read the article in the July Provider Partner Update


Recent Announcements

CME Webinar Series: Introducing Physicians and their teams to Value-Based Health Care

Please join us for a new CME-accredited webinar series on value-based care. This series is designed to introduce practicing physicians and their teams to value-based health care. Over the course of six sessions, we will define the components of value and identify the tools necessary to deliver high-value care for a population.
Feb. 2026Education/Webinars

Bridging Smiles and Systems: Collaborative Care for Children with Chronic Conditions

Please join us for a live, CME-accredited and CEU-accredited webinar on May 13 from noon to 1p.m., that will explore the critical connection between oral health and pediatric chronic conditions such as diabetes, asthma, congenital heart disease, and ADHD.
Feb. 2026Education/Webinars

February 2026 UPMC for You and UPMC Community HealthChoices formulary update

Pulmicort Flexhaler has a new distributor, Rubicon Holding. National Drug Codes (NDCs) for Pulmicort Flexhaler from Rubicon Holding are not included in the Medicaid Drug Rebate program and are not covered under the Medicaid Prescription Drug Program. Pulmicort Flexhaler NDCs from the previous manufacturer, H2 Pharma, have been discontinued but may be billed/dispensed until supplies are exhausted.
Feb. 2026Pharmacy Updates