All PlansPrior AuthHigh impact
Special notice: Important policy changes
UPMC Health Plan·Oncology, Radiology, Cardiology +2 more·Prior Authorization
Effective date
May 1, 2025
We identified it
Jun 20, 2026
Summary
Effective May 1, 2025, five existing medical policies are being retired and replaced with new policies that require prior authorization. The affected services include brachytherapy, implantable loop recorders, external beam radiation therapy, stereotactic radiation therapy, and sleep studies.
Action Required
By May 1, 2025: Billing team must update systems to require prior authorization for all brachytherapy, implantable loop recorder placement, external beam radiation therapy (EBRT/IMRT), stereotactic radiation therapy (SRS/SBRT), and sleep study procedures. Update encounter forms and EMR templates to alert providers that prior auth is mandatory. Contact Provider Services at 1-866-918-1595 for specific authorization requirements. Claims submitted without prior authorization will be denied.