All PlansPrior AuthHigh impact
Pause in Prior Authorization Policies
UPMC Health Plan·Sleep Medicine, Oncology, Radiology +1 more·Prior Authorization
Effective date
May 1, 2025
We identified it
Jun 20, 2026
Summary
UPMC Health Plan is suspending or eliminating prior authorization requirements for several services effective May 1, 2025. Sleep studies no longer require prior auth permanently, while radiation therapy services and colonoscopy procedures have suspended prior auth requirements until June 1 and July 1, 2025 respectively.
Action Required
Effective May 1, 2025: Billing team must immediately update billing system to REMOVE prior authorization requirements for sleep study codes 95800, 95801, 95805, 98506, G0398, G0399, G0400. Also remove prior auth requirements for radiation therapy services (policies MP.PA.143, MP.PA.139, MP.PA.142) and diagnostic colonoscopy (policy MP.PA.147) until their respective suspension end dates. Update encounter forms and staff workflows to reflect these changes.