All PlansCoverageMedium impact
Prescription for Wellness order set updates
UPMC Health Plan·PA · Endocrinology, Internal Medicine, Family Medicine +1 more·Pharmacy
Effective date
Nov 29, 2023
We identified it
Aug 7, 2026
Summary
Effective Nov. 29, 2023, UPMC's Prescription for Wellness order set has been expanded to include a new 'Diabetes & Metabolic Health' category with three service components (Certified Diabetes Care & Education Specialist, Diabetes Health Coaching, and Diabetes Prevention Program) and added 'Employment' as a topic under Patient/Family Support Services. The billing team must ensure these new wellness services are properly coded and billed under the updated order set guidelines.
Action Required
By Nov. 29, 2023: Billing team and providers must review the updated Prescription for Wellness order set and ensure familiarity with the new 'Diabetes & Metabolic Health' category and 'Employment' topic additions. Verify that EHR/billing systems reflect these service options in the order set. Coordinate with clinical staff to identify appropriate encounter templates and ensure new services are captured during member engagement. Contact Jamie Delu at RxforWellness@upmc.edu for implementation questions or technical support. Failure to utilize updated services may result in missed reimbursement opportunities for preventive wellness care.