CommercialPrior AuthHigh impact
Musculoskeletal procedures update
UPMC Health Plan·Orthopedics, Podiatry·Provider Announcement
Effective date
Feb 1, 2024
We identified it
Jun 20, 2026
Summary
Effective February 1, 2024, UPMC Health Plan will require prior authorization for specific musculoskeletal procedures including arthrodesis, arthroscopy, arthrotomy, bunionectomy, plantar fascial release, and radius/ulna fracture repair procedures. Authorization requests will be evaluated using Interqual Connect criteria and must be submitted through the established prior authorization process.
Action Required
Before February 1, 2024: Billing team must update system to require prior authorization for all listed musculoskeletal procedure codes. Update scheduling workflow to obtain prior auth before procedures. Train staff to use upmchp.us/PriorAuth portal and Provider OnLine for authorization submissions. Claims will be denied without proper authorization.