Clinical Review Criteria — Medicare-only: Durable Medical Equipment (DME) compendium
Lists Kaiser Permanente Clinical Review Criteria that apply to Medicare-only coverage decisions for durable medical equipment (DME) and related services; intended for KP Washington providers and staff to identify applicable policies and links.
No material clinical or coverage changes in this revision.
Coverage direction and scope
Coverage governed by referenced policies
This document does not itself contain item-level medical necessity criteria; coverage determinations are controlled by the specific NCD/LCD/LCA or policy article listed for each equipment or service.
This index groups many policies (DME, radiology, laboratory, procedures) and points to those individual policies for detailed criteria.
This compendium of Clinical Review Criteria applies only to Kaiser Foundation Health Plan of Washington and Kaiser Foundation Health Plan of Washington Options, Inc.. It is intended for internal use by Kaiser Permanente members and healthcare providers and is not for marketing or external publicity.
The Clinical Review Criteria are developed to assist in administering plan benefits; they do not constitute medical advice and do not guarantee coverage. Kaiser Permanente may modify or revoke these criteria at its discretion. Coverage for any specific service is governed by the member's contract and Evidence of Coverage; providers should always verify benefits or contact Kaiser Permanente Member Services to determine coverage for an individual patient.
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