Special notice: Important policy changes

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.