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)

Ambulance services (PDF)

Applied behavioral analysis (ABA) therapy (PDF)

Assistant surgeon (PDF)

BRACAnalysis Large Rearrangement Test (BART) (PDF)

Code editing (PDF)

Computer-aided detection (CAD) for mammography (PDF)

Cosmetic procedures (PDF)

Diagnosis Related Group (DRG) Payment and Review (PDF)

Drug Waste (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)

Fetal non-stress tests (PDF)

High level evaluation and management services with a diagnosis of "no abnormal findings" (PDF)

Influenza vaccinations (PDF)

Injectable drugs (PDF)

Manipulative services (chiropractic) (PDF)

Modifiers (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-covered services (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)

Unlisted codes (PDF)

Urine drug screen (PDF)

Venipuncture (PDF)

Virtual care (PDF)

Women's health (PDF)

Content on this page is from the provider manual | Disclaimer