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)

Ambulance services (PDF)

Applied behavioral analysis (ABA) therapy (PDF)

Assistant surgeon (PDF)

BRACAnalysis Large Rearrangement Test (BART) (PDF)

Clinical review payment determination policy (PDF)

Code editing (PDF)

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

Cosmetic procedures (PDF)

Durable medical equipment (PDF)

Early elective deliveries (PDF)

Evaluation & Management (E&M) services with preventive services (PDF)

Facility charges for evaluation and management services (PDF)

Fetal non-stress tests (PDF)

Influenza vaccinations (PDF)

Injectable drugs (PDF)

Manipulative services (chiropractic) (PDF)

Modifiers (PDF)

Multiple procedure payment reduction (MPPR) (PDF)

Non-contracted provider reimbursement (PDF)

Non-covered services (PDF)

Non-preventive services provided during a preventive visit (PDF)

Pharmacist reimbursement (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)

Telehealth Services (Medicare) (PDF)

Telemedicine services (Commercial) (PDF)

Unlisted codes (PDF)

Urine drug screen (PDF)

Venipuncture (PDF)

Virtual care (PDF)

Content on this page is from the provider manual | Disclaimer