Prior authorization for durable medical equipment
Most but not all Kaiser Permanente plans provide some coverage for durable medical equipment (DME). Plans may have variable levels of coverage, deductibles, copayments, or coinsurance.
We contract with multiple vendors to meet our members' DME needs. Coverage varies greatly for DME. To determine coverage, use the Eligibility Inquiry tool. To see medical necessity review criteria, see clinical review criteria. Contact Review Services or the Provider Assistance Unit for information about coverage and medical necessity criteria.
You can make DME prior authorization requests by contacting Review Services or using our Referral Request tool.
Effective Aug. 1, 2013, Kaiser Permanente expanded its partnership with Apria Healthcare to an exclusive provider relationship for certain core DME services. Under this relationship, Apria provides a list of core services (PDF) for Kaiser Permanente HMO members.
Once your order is received, Review Services will:
- Verify patient eligibility and benefits.
- Review guidelines and authorize or deny requests based on established Medicare or health plan criteria.
- Review and determine cost-effectiveness of equipment purchase versus rental.
For coordination of equipment delivery and pickup, contact the vendor.
Urgent after-hours needs
You may obtain urgent and emergent equipment after normal business hours by contacting Apria Healthcare at 1-800-562-6505 or a branch office found on its website. The equipment company will not accept direct orders from providers unless our offices are closed. This service is available in Western Washington only.
Items typically required after-hours include:
- Hospital beds
- Breast pumps
Other items may also be available.
Content on this page is from the provider manual | Disclaimer