Certified Community Health Worker (CCHW) Provider Billing Notification

UPMC for You will now reimburse for up to three certified community health worker (CCHW) visits per member per calendar year for Medicaid recipients, per the Pennsylvania Department of Human Services (PA DHS).

CCHWs must be enrolled in the Medical Assistance program and documented on the claim as the rendering/servicing provider.

Please refer to the Billing Guide for guidance on applicable codes, documentation, and specifications. This does not apply to Community HealthChoices participants.

UPMC Health Plan does not practice medicine or exercise control over the methods or professional judgments by which providers render medical services to members. Nothing in these materials should be construed to supersede or replace the clinical judgment of a provider.