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

Clinical documentation required for hip, knee, and shoulder prior authorizations

As you know, UPMC Health Plan requires certain clinical documentation/notes in support of a request for prior authorization for hip, knee, and shoulder procedures 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.
Jul. 2025Important Notices

Clinical documentation required for hip, knee, and shoulder prior authorizations

As you know, UPMC Health Plan requires certain clinical documentation/notes in support of a request for prior authorization for hip, knee, and shoulder procedures 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.
Jul. 2025Important Notices

Register for the Oral Health in Your Pediatric Office CME -accredited webinar

Please join us for a live, CME-accredited webinar on Wednesday, Sept. 10 from noon to 1 p.m. that will provide an overview of oral health in your pediatric office. Providers with a(n) MD/DO, PA, CRNP, RN, or LPN may also apply for topical fluoride certification after completion of this course.
Jun. 2025Education/Webinars