Special notice: Important policy changes
May 2025Important Notices
Effective June 1, 2025, UPMC Health Plan will be implementing policy changes that will require providers to obtain prior authorizations for services listed in the following policies. For more information, please visit upmchp.us/policiesandprocedures.
- Varicose Veins – MP.066 is being retired and will be replaced by Varicose Veins – MP.PA.145.
- Genetic Testing – Hereditary and Multifactorial Diseases – MP.PA.118 is a new prior authorization policy.
- Laparoscopic Cholecystectomy, 18 Years Old and Older – MP.PA.146 is a new prior authorization policy.
- Diagnostic and Surveillance Colonoscopy, 18 Years Old and Older – MP.PA.147 is a new prior authorization policy.
- Cardiac Ablation Procedures, 18 Years Old and Older – MP.PA.148 is a new prior authorization policy.
Again, prior authorizations will be implemented in accordance with these policies beginning June 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
PA DOH Antibiotic Stewardship Resources
Order antibiotic stewardship resources at no costJun. 2026Important Notices
Medical device correction: Omnipod (Insulet – May 2026)
Insulet Corporation Inc. has announced a medical device correction for certain Omnipod Pods. These pods are wearable devices that are used to deliver insulin.Jun. 2026Pharmacy Updates
Clinical documentation required for medical policy prior authorizations
As you know, UPMC Health Plan requires certain clinical documentation/notes in support of a request for prior authorization for the listed procedures below in accordance with its established policies and procedures, in addition to CMS requirements that medical record documentation must support the medical necessity of the services requested.Jun. 2026Important Notices