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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 UM Criteria Commercial (PDF)
- Acupuncture UM Criteria Medical EPSDT (PDF)
- Acupuncture UM Criteria Medicare (PDF)
B
- Behavioral Health Treatment Services UM Criteria Commercial EPSDT(PDF)
- Behavioral Health Treatment Services UM Criteria Medi-Cal EPSDT (PDF)
D
- Dental Anesthesia UM Criteria Commercial (PDF)
- Dental Anesthesia UM Criteria Medi-Cal (PDF)
- Dental Anesthesia UM Criteria Medicare (PDF)
H
- Home Health Shift Care / Private Duty Nursing Services UM Criteria Commercial EPSDT (PDF)
- Home Health Shift Care / Private Duty Nursing Services UM Criteria Medi-Cal EPSDT (PDF)
- Home Health Shift Care / Private Duty Nursing Services UM Criteria Medicare (PDF)
- Home Venipuncture Service UM Criteria Commercial (PDF)
- Home Venipuncture Service UM Criteria Medicare (PDF)
- Home Venipuncture Service UM Criteria Medi-Cal (PDF)
O
- Occupational and Physical Therapy Services Commercial (PDF)
- Occupational and Physical Therapy Services Medi-Cal (PDF)
P
- Panniculectomy UM Criteria Commercial (PDF)
- Panniculectomy UM Criteria Medi-Cal EPSDT (PDF)
- Panniculectomy UM Criteria Medicare (PDF)
R
- Reduction Mammoplasty UM Criteria Commercial (PDF)
- Reduction Mammoplasty UM Criteria Medi-Cal EPSDT (PDF)
- Reduction Mammoplasty UM Criteria Medicare (PDF)
S
- Spinal Cord Stimulation UM Criteria Commercial (PDF)
- Spinal Cord Stimulation UM Criteria Medicare (PDF)
- Spinal Cord Stimulation UM Criteria Medi-Cal EPSDT (PDF)
- Speech Language Therapy UM Criteria Commercial (PDF)
- Speech Language Therapy UM Criteria Medi-Cal EPSDT (PDF)
- Speech Language Therapy UM Criteria Medicare (PDF)