All PlansPrior AuthHigh impact
Understanding MP.PA.147
UPMC Health Plan·Gastroenterology, General Surgery, Internal Medicine·Provider Announcement
Effective date
Jul 1, 2025
We identified it
Aug 7, 2026
Summary
Effective July 1, 2025, MP.PA.147 policy now requires prior authorization for diagnostic and surveillance colonoscopy codes across all lines of business. This is a significant billing workflow change that excludes only screening colonoscopies. Providers must also ensure proper use of modifiers (33 and PT) to distinguish screening exams from diagnostic/surveillance procedures to avoid claim denials.
Action Required
By June 30, 2025: Billing team must update billing system to require prior authorization for all diagnostic and surveillance colonoscopy codes per MP.PA.147 policy. Providers must be trained to distinguish screening colonoscopies (modifier 33 or PT, no prior auth required) from diagnostic/surveillance colonoscopies (requires prior auth). Update encounter templates and billing software rules to enforce prior auth requirement. Ensure all staff review the Colorectal Cancer Screening Billing Guide for proper modifier usage. After July 1, 2025, claims for diagnostic and surveillance colonoscopies submitted without prior authorization will be denied. Front desk and clinical staff must verify which colonoscopy type is being performed at scheduling to initiate prior auth appropriately.