Complementary and alternative medicine
Kaiser Permanente provides options for members to access complementary and alternative care and manipulative therapy services, otherwise known as complementary and alternative medicine (CAM). These services include acupuncture, naturopathy, massage therapy, and manipulative therapy services provided by chiropractors. Eligibility varies based on the member's health plan and benefit level.
Members can use the Complementary Choices℠ discount program (see below) when their alternative or complementary care doesn't meet coverage or clinical review criteria or after they have exhausted their self-referral limit. Complementary Choices provides a discount on professional fees from a limited network of contracted providers.
Most plans cover a limited number of self-referred acupuncture, naturopathy, and manipulative therapy visits. Most plans also cover massage therapy visits with a referral from the primary care provider or personal physician. Providers and members can confirm coverage and visit limits by contacting Member Services. Providers are encouraged to verify coverage before delivering services.
Kaiser Permanente contracts with Tivity, formerly Healthways to manage our network of chiropractors, naturopaths, acupuncturists, and massage therapists. All contracted chiropractic and CAM providers meet Kaiser Permanente's credentialing standards and state or local licensing requirements. Members may identify these providers by using our Provider Directory.
These services follow the same copayment and billing standards as all other covered services. Please refer the member to Member Services for questions about benefit visit limits, copayments, coinsurance, and other coverage issues.
|Service||Requires Prior Authorization|
|Acupuncture and naturopathy||No, if the member's total annual visits are within their self-referral visit limit. Members are encouraged to use their self-referral visits to access care. |
If the member needs or requests additional visits after exhausting their self-referral limit, the acupuncturist or naturopathic physician typically requests a prior authorization directly from Kaiser Permanente. No personal physician involvement is needed.
|Chiropractic||No. Most commercial groups have a limited self-referral manipulative therapy benefit. Medicare services must meet Medicare's medical necessity guidelines for coverage. |
When the member's plan requires authorization or medical necessity review, the chiropractor requests prior authorization from Tivity for additional care. No personal physician involvement is needed. Prior authorization requirements vary by plan through most plans do not require it. Please call Provider Assistance to validate.
|Massage therapy||Massage therapy is covered as part of the rehabilitation therapy benefit and must be ordered and referred by a personal or attending physician as part of the rehabilitation plan of care. Massage therapy services must be medically necessary and meet Kaiser Permanente's clinical review criteria. It is not covered for relaxation, stress reduction, prevention, or maintenance therapy. If a commercial member needs or requests additional visits after their pre-authorized visit limit, when required, the massage therapist typically requests an authorized extension directly from Kaiser Permanente. Additional visits must be included in a physician-ordered rehabilitation plan of care and meet Kaiser Permanente's medical necessity and clinical review guidelines.|
Massage therapy may not be referred by chiropractors, naturopathic physicians, or acupuncturists.
Exception: Members on a PPO plan, the prescription can be written by any provider, including a chiropractor.
Providers must use a Kaiser Permanente form when ordering and scheduling radiology procedures at Kaiser Permanente. You can get a copy of the form from the Tivity web site or by contacting your local Kaiser Permanente clinic's radiology department.
As of Jan. 1, 2009, we provide digital copies only of your patients' X-rays. You can get more information about how to order and use the PACS (Picture Archiving and Communication System) digital images from your Tivity Kaiser Permanente Provider Manual Supplement. Also see Viewing Kaiser Permanente radiology images on encrypted discs with iSite Viewer (PDF) and viewing Kaiser Permanente radiology images on encrypted discs with EZDicom Viewer (PDF).
The Complementary Choices program offers a discount on professional fees from providers in the Tivity Kaiser Permanente Complementary Choices contracted network when a member's alternative or complementary care doesn't meet coverage or clinical review criteria, or after a member has exhausted their self-referral limit. Members may use their program discount for an unlimited number of office visits, classes, and sessions.
Massage, acupuncture, naturopathy, and chiropractic
To find massage therapy, acupuncture, naturopathy, and chiropractic providers, use the Kaiser Permanente Provider Directory. Select "All Specialists" for provider type, then select the type of specialist you are looking for. Services from these providers are eligible for the Complementary Choices discount.
Fitness training, yoga, tai chi, and Pilates
The Complementary Choices program also offers discounts for certain wellness and prevention services that are not covered by our health plans, including personal fitness and exercise trainers and yoga, tai chi, and Pilates instructors. Members can find a trainer or instructor in the Complementary Choices directory.
The Complementary Choices discount does not apply to laboratory tests, X-rays, or any products the provider may recommend, including herbal or nutritional supplements (or nutraceuticals). The discount also does not apply to copayments or coinsurance for covered services.
For more information
Refer members to Complementary and Alternative Medicine on the public Web site and to their coverage documents or Member Services for more information. To learn more about complementary and alternative plan coverage, contact the Provider Assistance Unit.
Content on this page is from the provider manual | Disclaimer