MedicaidCoverageMedium impact
Certified Community Health Worker (CCHW) Provider Billing Notification
UPMC Health Plan·PA · Family Medicine, Internal Medicine, General Practice +1 more·Reimbursement
We identified it
Jun 20, 2026
Summary
UPMC for You will now reimburse for up to three certified community health worker (CCHW) visits per member per calendar year for Medicaid recipients. CCHWs must be enrolled in the Medical Assistance program and documented on the claim as the rendering/servicing provider.
Action Required
Immediately: Billing team must refer to the UPMC Billing Guide for applicable CCHW codes, documentation requirements, and specifications. Ensure CCHWs are enrolled in Medical Assistance program before billing. Document CCHWs as rendering/servicing provider on claims. Limit to maximum 3 visits per Medicaid member per calendar year. Note: Does not apply to Community HealthChoices participants.