All PlansPrior AuthHigh impact
Special notice: Important policy changes
UPMC Health Plan·Radiation Oncology, Cardiology, Sleep Medicine·Prior Authorization
Effective date
May 1, 2025
We identified it
Aug 7, 2026
Summary
Effective May 1, 2025, UnitedHealthcare will retire five existing medical policies and replace them with new prior authorization (PA) requirements. Affected procedures include brachytherapy, implantable loop recorders, external beam radiation therapy, stereotactic radiology, and sleep studies. Prior authorization will be mandatory for all five replaced policies beginning May 1, 2025.
Action Required
By April 30, 2025: Billing team and providers must implement prior authorization requirements for all five procedures. (1) Update billing system rules to REQUIRE prior authorization submission before claims processing for: brachytherapy (new policy MP.PA.139), implantable loop recorders (new policy MP.PA.140), external beam/IMRT radiation therapy (new policy MP.PA.142), SRS/SBRT radiation therapy (new policy MP.PA.143), and sleep studies (new policy MP.PA.144). (2) Update encounter forms and clinical workflows to prompt providers to obtain prior authorization BEFORE scheduling these procedures. (3) Retire old policy numbers MP.220, MP.165, MP.034, MP.060, and MP.157 from all billing references. (4) Train front desk and scheduling staff to verify prior authorization is obtained before procedure dates. (5) Communicate with radiation oncology, cardiology, and sleep medicine departments about the new requirements. Consequence: Claims submitted without prior authorization will be denied, resulting in delayed payments and potential patient balance issues. Contact Provider Services at 1-866-918-1595 or account executive for implementation support. Reference: https://www.upmchealthplan.com/providers/medical/announcements-updates/announcements/2025-announcements/2025-03-special-notice-important-policy-changes