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Clinical review
For information concerning whether a specific service or benefit is covered, please refer to your Evidence of Coverage, or call Kaiser Permanente Member Services toll-free at 1-800-464-4000
The documents below are available to detail the review process and procedures:
A
- Acupuncture Commercial UM Criteria (PDF)
- Acupuncture MediCal UM Criteria (PDF)
- Acupuncture Medicare UM Criteria (PDF)
B
- Behavioral Health Treatment Services Commercial UM Criteria (PDF)
- Behavioral Health Treatment Medi-Cal UM Criteria (EPSDT) (PDF)
C
- Chiropractic Services Commercial UM Criteria (PDF)
- Chiropractic Services Medi-Cal UM Criteria (EPSDT) Under the Age of 21 (PDF)
- Chiropractic Services Medicare UM Criteria (PDF)
- Community Based Adult Services Medi-Cal UM Criteria (EPSDT) Under the Age of 21 (PDF)
D
- Dental Anesthesia Commercial UM Criteria (PDF)
- Dental Anesthesia Medi-Cal UM Criteria (EPSDT) Under the Age of 21 (PDF)
- Dental Anesthesia Medicare UM Criteria (PDF)
H
- Home Health Shift Care / Private Duty Nursing Commercial UM Criteria (PDF)
- Home Health Shift Care / Private Duty Nursing Medi-Cal UM Criteria (EPSDT) Under the Age of 21 (PDF)
- Home Health Shift Care / Private Duty Nursing Medicare UM Criteria (PDF)
- Hyperbaric Oxygen (HBO) / Systemic Commercial UM Criteria (PDF)
- Hyperbaric Oxygen (HBO) / Systemic Medi-Cal UM Criteria (EPSDT) Under the Age of 21 (PDF)
- Hyperbaric Oxygen (HBO) / Systemic Medicare UM Criteria (PDF)
O
- Occupational and Physical Therapy Services Commercial UM Criteria (PDF)
- Occupational and Physical Therapy Services Medi-Cal UM Criteria (EPSDT) Under the Age of 21 (PDF)
- Occupational and Physical Therapy Services Medicare UM Criteria (PDF)
S
- Speech and Language Therapy Services Commercial UM Criteria (PDF)
- Speech and Language Therapy Services Medi-Cal UM Criteria (EPSDT) Under the Age of 21 (PDF)
- Speech and Language Therapy Services Medicare UM Criteria (PDF)
U