Special notice: Important policy changes

Mar. 2025Important Notices

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.

Recent Announcements

Community Care Behavioral Health is excited to announce this free upcoming web-based training opportunity:

A growing body of U.S. and international research demonstrates that the rapid legalization and commercialization of gambling—including online casinos and mobile sports betting platforms—are associated with significant and escalating gambling related harm. Although Pennsylvania specific prevalence data remain limited, available evidence is increasingly concerning, with gambling disorder linked to alarmingly high rates of suicide, psychiatric comorbidity, and social and financial harm. Drawing on lessons from the tobacco and opioid crises, this presentation will examine how delayed recognition and regulation can amplify population level harm, underscoring the need for earlier screening, prevention, and policy engagement. Participants will gain practical guidance on identifying patients at elevated risk, implementing evidence informed screening and diagnostic strategies, and applying current treatment approaches across the lifespan.
May 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.
Apr. 2026Education/Webinars

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).
Apr. 2026Important Notices