Kaiser Permanente payment policies
Payment policies are designed to assist you when submitting claims to Kaiser Permanente. They are consistently updated to promote accurate coding and policy clarification.
If you have questions or would like more information, contact the Provider Assistance Unit toll-free at 1-888-767-4670.
All materials are in a print-friendly PDF format, and will open in a new tab.
Access, Elect, and Kaiser Permanente Options Federal plans out-of-network reimbursement (PDF)
Admission and Post Stabilization Requirement (PDF)
Applied behavioral analysis (ABA) therapy (PDF)
BRACAnalysis Large Rearrangement Test (BART) (PDF)
Computer-aided detection (CAD) for mammography (PDF)
Diagnosis Related Group (DRG) Payment and Review (PDF)
Durable medical equipment (PDF)
Early elective deliveries (PDF)
Emergency Department (ED) Facility Evaluation and Management (E/M) Coding Policy (PDF)
Evaluation & Management (E&M) services with preventive services (PDF)
Facility charges for evaluation and management services (PDF)
High level evaluation and management services with a diagnosis of "no abnormal findings" (PDF)
Manipulative services (chiropractic) (PDF)
Multiple procedure payment reduction (MPPR) - outpatient hospital claims (PDF)
Multiple procedure payment reduction (MPPR) - multiple diagnostic imaging (PDF)
National Drug Code (NDC) billing requirements (PDF)
Neurostimulator electrode (PDF)
Non-contracted provider reimbursement (PDF)
Non-preventive services provided during a preventive visit (PDF)
Pharmacist reimbursement (PDF)
Prepayment bill review - line item deduction (LID) (PDF)
Prepayment Bill Review - Medical Necessity (PDF)
Prepayment bill review - trauma (PDF)
Robotic assisted surgery (PDF)
Self-treatment or treatment of immediate family members (PDF)
Services incidental to inpatient admissions (PDF)
Shared medical appointments (group visits) (PDF)
Surgical codes - Anatomical modifiers (professional claims) (PDF)
Telehealth services (Medicare) (PDF)
Telemedicine services (Commercial) (PDF)
Content on this page is from the provider manual | Disclaimer