All PlansPrior AuthHigh impact
Understanding MP.PA.147
UPMC Health Plan·Gastroenterology, General Surgery·Provider Announcement
Effective date
Jul 1, 2025
We identified it
Jun 20, 2026
Summary
Effective July 1, 2025, policy MP.PA.147 now requires prior authorization for many diagnostic and surveillance colonoscopy codes across all lines of business. The policy also clarifies billing requirements for screening colonoscopies, including proper use of modifiers 33 and PT.
Action Required
By July 1, 2025: Billing team must update system to require prior authorization for diagnostic and surveillance colonoscopy codes covered under MP.PA.147 across all plan types. Update encounter forms and EMR templates to remind providers to obtain prior auth before scheduling diagnostic/surveillance colonoscopies. Review the Colorectal Cancer Screening Billing Guide for proper use of modifier 33 and PT on screening exams. Claims without prior authorization will be denied.