CommercialPrior AuthHigh impact
Special notice: Important policy changes
UPMC Health Plan·Vascular Surgery, General Surgery, Gastroenterology +3 more·Provider Announcement
Effective date
Jun 1, 2025
We identified it
Jun 20, 2026
Summary
UPMC Health Plan is implementing new prior authorization requirements for five service categories effective June 1, 2025. This includes replacing the existing varicose veins policy and adding new prior auth requirements for genetic testing, laparoscopic cholecystectomy, colonoscopy, and cardiac ablation procedures for patients 18 and older.
Action Required
By June 1, 2025: Billing team must update system to require prior authorization for varicose vein treatments (new policy MP.PA.145), genetic testing for hereditary diseases, laparoscopic cholecystectomy, diagnostic and surveillance colonoscopy, and cardiac ablation procedures for patients 18+. Update encounter forms and EMR alerts to remind providers. Contact Provider Services at 1-866-918-1595 for specific authorization requirements. Claims will be denied without proper prior authorization after June 1st.