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Download our authorization policies to learn more about our utilization management and authorizations process, including:
- the role of the Utilization Management Operations Center, our centralized
- authorization and referral department
- referral policies and procedures
- hospital and facility admissions
- case management
- denials and appeals
We provide medical coverage policies - referral guidelines as a reference for health care professionals within the Kaiser Permanente Medical Care Program. The Kaiser Permanente Mid-Atlantic States medical coverage policies may provide details about referring patients for treatment, including the following:
- diagnosis
- indications
- contraindications
- measures prior to referral
- clinical indications for referral
- optional approaches
If you would like to receive a hard copy of the Medical Coverage Policy, UM criteria/protocol or Affirmation Statement, please contact the Utilization Management Operations Center at 1-800-810-4766 and follow the prompts.
Pre-Certification for KPIC PPO & POS Product Plans
Permanente Advantage, LLC ensures our members receive necessary, appropriate, and safe care while helping them navigate the health system and make the most of their benefits.
Use this link, Permanente Advantage, to access online resources that support working with Permanente Advantage and provide information about precertification.
In 2022, to meet the growing demand for therapy and medication management for mental health conditions, we temporarily lifted the authorization requirement for initial consultations and some routine care services. We appreciate your help in caring for our patients to help us meet this surge in demand.
Now that we have stabilized our internal services and access, as well as our contracted provider network, we are working with our patients to internalize their care for some services including medication management and psychiatric follow-up care to the Mid-Atlantic Permanente Medical Group (MAPMG).
Effective June 11, 2025, the following CPT codes once again require authorization and have been removed from the list of authorization-waived services:
| CPT Code | Description |
|---|---|
| H0014 | ALCOHOL AND/OR DRUG SERVICES; AMBULATORY DETOX |
| G2068 | MEDICATION ASSISTED TREATMENT, BUPRENORPHINE; WEEKLY |
| 90833 | PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 30 MIN |
| 90836 | PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 45 MIN |
| 90838 | PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 60 MIN |
| 99202 | OFFICE/OUTPATIENT NEW SF MDM 15-29 MINUTES |
| 99203 | OFFICE/OUTPATIENT NEW LOW MDM 30-44 MINUTES |
| 99204 | OFFICE/OUTPATIENT NEW MODERATE MDM 45-59 MINUTES |
| 99205 | OFFICE/OUTPATIENT NEW HIGH MDM 60-74 MINUTES |
| 99211 | OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP |
| 99212 | OFFICE/OUTPATIENT ESTABLISHED SF MDM 10-19 MIN |
| 99213 | OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN |
| 99214 | OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30-39 MIN |
| 99215 | OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40-54 |
Pre-authorization is still not required for initial consultations and some services.
The full list of authorization-waived CPT codes and their descriptions are listed below:
Please Note – These services must be billed on a CMS-1500 form for the waive to apply as this list applies to professional services.
| CPT Code | Description |
|---|---|
| H0020 | ALCOHOL AND/OR DRUG SERVICES; METHADONE ADMIN/SERVICE |
| G2067 | MEDICATION ASSISTED TREATMENT, METHADONE; WEEKLY |
| G2078 | TAKE HOME SUPPLY OF METHADONE; UP TO 7 ADD DAY SUPPLY |
| 90791 |
PSYCHIATRIC DIAGNOSTIC EVALUATION |
| 90792 | PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES |
| 90832 | PSYCHOTHERAPY W/PATIENT 30 MINUTES |
| 90834 | PSYCHOTHERAPY W/PATIENT 45 MINUTES |
| 90837 | PSYCHOTHERAPY W/PATIENT 60 MINUTES |
| 90846 | FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS |
| 90847 | FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS |
| 90849 | MULTIPLE FAMILY GROUP PSYCHOTHERAPY |
| 90853 | GROUP PSYCHOTHERAPY |
| 90839 | PSYCHOTHERAPY FOR CRISIS |
| 90840 | EACH ADDITIONAL 15" FOR CRISIS |
| G0176 | ART THERAPY |
| 96127 | BRIEF EMOTIONAL/BEHAVIORAL ASSESSMENT |
| 99307 | SUBSEQUENT NURSING FACILITY CARE (10 MIN) |
| 99308 | SUBSEQUENT NURSING FACILITY CARE (15 MIN) |
| 99309 | SUBSEQUENT NURSING FACILITY CARE (25 MIN) |
The Kaiser Permanente Utilization Management Operations Center reviews each referral request and determines the number of visits that are medically necessary. When requesting referrals, please only request one visit or the exact number of visits that will be needed for a three (3) month period.
Additional visits can be added if medically necessary before approval but if more visits are requested than needed the member will receive a partial approval/denial letter which has been creating confusion for members as they believe their referral is being denied. To help avoid this, please only request one visit or the exact number of visits necessary.