Letters to Providers

The following letters contain updated Kaiser Permanente policy information or clinical reminders. Letters are in a print-friendly PDF format and will be available for one year.


Clarification Notification to Intraoperative Neurophysiological Monitoring (PDF)
This letter provides additional clarification to the previous letter regarding Intraoperative Neurophysiological Monitoring. The new notification does not change the effective date of September 1, 2019. This letter clarifies Medicare Advantage review for Intraoperative Neurophysiological Monitoring.

Intraoperative Neurophysiological Monitoring (PDF)
Effective September 1, 2019, Kaiser Permanente is changing the medical necessity review criteria and requiring pre-authorization for coverage on some plans. Kaiser Permanente has adopted Kaiser Permanente National criteria for Intraoperative Neurophysiological Monitoring for the Washington region.

IV Immune Globulin (IVIG) in the Home Infusion Setting Will Be Restricted to Kaiser Washington Home Infusion (PDF)
Effective August 1, 2019, the criteria for the products listed will be updated. These products will be restricted to Kaiser Washington Home Infusion when administered in the home infusion setting for non-Medicare patients.

Alpha-1 Proteinase Inhibitors in the Home Infusion Setting Will Be Restricted to Kaiser Washington Home Infusion (PDF)
Effective June 1, 2019, the criteria for the products listed will be updated. These products will be restricted to Kaiser Washington Home Infusion when administered in the home infusion setting for non-Medicare patients.

Clarification Notification to Changes to Medical Necessity Review Criteria for Total Knee Replacement (PDF)
This letter provides additional clarification to the previous letter regarding total knee replacement. This new notification does not change the effective date of June 1, 2019. This letter clarifies Medicare Advantage review for total knee replacements in an inpatient setting.

Changes to Medical Necessity Review Criteria for Total Knee Replacement (PDF)
Effective June 1, 2019, Kaiser Permanente will implement medical necessity criteria for Total Knee replacements performed in an inpatient setting.

Tivity/WholeHealth Network Notice Re: Group Summary and Fee Schedule Update for Chiropractors (PDF)
The Group Summary and Fee Schedule has been updated. Reimbursement for services provided on or after 01/01/2019 will be based on the updated fee schedule for chiropractic claims.

Change to prior authorization requirement for non-invasive prenatal fetal testing(PDF)
Effective March 1, 2019, Kaiser Permanente is changing the utilization management requirement for non-invasive prenatal fetal testing.

Changes to medical necessity review criteria for total knee replacement (PDF)
Effective March 1, 2019, Kaiser Permanente will implement medical necessity criteria for Total Knee replacements performed in an inpatient setting.

Buprenorphine (Probuphine®) will require prior authorization(PDF)
Effective February 1, 2019, prior authorization review will be required for buprenorphine (Probuphine®).

Paclitaxel protein-bound particles (Abraxane®) will require prior authorization (PDF)
Effective February 1, 2019, prior authorization review will be required for Paclitaxel protein-bound particles (Abraxane®).

Secukinumab (Cosentyx®) will not be covered under the medical benefit (PDF)
Effective February 1, 2019, Secukinumab (Cosentyx®) will NOT be covered under the medical benefit.

Tocilizumab (Actemra®) will not be covered under the medical benefit (PDF)
Effective February 1, 2019, Tocilizumab (Actemra®) will NOT be covered under the medical benefit.

Multiple procedure payment reduction (PDF)
Effective November 8, 2018, Kaiser Permanente will begin to apply our multiple imaging reduction payment policy. When benefits allow, Kaiser Permanente will apply the Multiple Procedure Payment Reduction on Diagnostic Imaging, implemented by CMS in 2012.

Darbepoetin alfa (Aranesp®) for ESRD will require prior authorization (PDF)
Darbepoetin alfa (Aranesp®) for use in patients with end-stage renal disease (ESRD) will be added to the list of non-Medicare medical benefit drugs requiring prior authorization.

Claims PO Box updated (PDF)
This is a notification that our Claim’s PO Box is UPDATED. Please send all future paper claims submissions to: PO Box 30766 Salt Lake City, UT 84130-0766.

Services incidental to inpatient admissions (PDF)
** Critical access hospitals are excluded from this policy**
Effective September 1, 2018
Kaiser Permanente will begin to apply our services incidental to inpatient hospital stay payment policy. When benefits allow, Kaiser Permanente will reimburse incidental services to the inpatient admission on the inpatient claim. Incidental services are considered included in the inpatient reimbursement rate. Kaiser Permanente will NOT reimburse services rendered prior to the related inpatient admission separately.

Changes to medical necessity review criteria for Kaiser Permanente: Implantable loop recorders (PDF)
Effective July 1, 2018 Kaiser Permanente is changing the medical necessity review criteria for implantable loop recorders.

Infliximab (Remicade®) updated prior authorization approval (PDF)
Effective June 1, 2018, the criteria for infliximab (Remicade®) will be updated. This letter is a notification of the upcoming change in prior authorization approval required before administering this medication in a physician's office.

Important changes in pre-authorization requirements for Kaiser Permanente Washington’s Access PPO, Elect PPO or Omni PPO Plans (PDF)
Effective May 1, 2018 Kaiser Permanente Washington is changing our pre-authorization requirements for our Access PPO, Elect PPO or Omni PPO plans.

Site of service prior authorization requirement for additional medications (PDF)
Effective April 1, 2018, site of service prior authorization criteria will apply to additional drugs. This letter is a notification of the upcoming change in prior authorization approval requirements before administering these medications under the medical benefit. This only applies to Kaiser Foundation Health Plan of Washington commercial PPO and HMO plans and will not affect Medicare members.

All blood factor products to be dispensed through BloodWorks NW (PDF)
Effective April 1, 2018, all blood factor products listed will be restricted to BloodWorks NW for non-Medicare patients. This letter is a notification of the upcoming change that the list of blood factors will NOT be covered outside of BloodWorks NW.

Ferric carboxymaltose (Injectafer®) and ferumoxytol (Feraheme) will require prior authorization (PDF)
Effective April 1, 2018, prior authorization review will be required for ferric carboxymaltose (Injectafer®) and ferumoxytol (Feraheme). This letter is a notification of the upcoming change in prior authorization approval required before administering this medication under the medical benefit.

Immune globulin (Hizentra®) will not be covered under the medical benefit (PDF)
Effective April 1, 2018, Immune globulin (Hizentra®) will NOT be covered under the medical benefit. This letter is a notification of the upcoming change in coverage for this medication under the medical benefit.