CurrentKaiser PermanentePolicy N/A

New and Emerging Medical Technologies and Procedures

Kaiser Permanente Clinical Review Criteria listing new and emerging medical technologies and procedures considered unproven for Non‑Medicare members; provides CPT/HCPCS/PLA/Proprietary codes and descriptions for items considered new/emerging. Medicare guidance supersedes when available.

Policy Summary

PayerKaiser Permanente

PolicyNew and Emerging Medical Technologies and Procedures

Policy CodePolicy N/A

Change TypeCode additions/removals and maintenance (non‑material and one material clarification)

Effective Date

Next Review Date

Key ActionAlways consult the patient's Evidence of Coverage or call Member Services to determine coverage for a specific medical service.

POLICY UPDATE CHANGES

Multiple CPT and HCPCS codes were added on various dates (e.g., new codes from 04/2020 through 01/01/2024 included across revisions).

Removed codes: K1018, K1019 (03/18/2024); CPT 0380U (07/01/2024); CPT V2525 (12/10/2024); CPT 87154 (12/24/2024); and others as noted.

Added review requirement to code C9757, requires 60-day notice, effective 9/1/2024.

Updated applicable codes effective various dates including new and termed codes effective 1/1/2024 and other quarterly updates.

200+Listed Codes/Tests/Procedures

Non‑MedicarePrimary Applicability

Medicare guidance prevailsMedicare Members

169U-codes listed (approx)

MultipleRevision events (2020-2025)

1Codes with special review (C9757)

Coverage Summary — New & Emerging Technologies (Non‑Medicare Members)

These Clinical Review Criteria summarize new and emerging medical technologies and procedures that Kaiser Permanente considers to have unproven benefit for Non‑Medicare members because current scientific evidence is insufficient to establish an impact on health outcomes. For Medicare members, Kaiser Permanente follows CMS coverage guidance and Medicare source materials prevail where there is a conflict. The primary applicability of these criteria is to Non‑Medicare members.

These criteria are provided to assist in administering plan benefits and do not constitute medical advice or guarantee coverage; member Evidence of Coverage and Member Services should be consulted for specific coverage decisions.

Key facts — New & Emerging Technologies (compact)

Primary ApplicabilityNon‑Medicare

Medicare MembersMedicare guidance prevails

Listed Codes/Tests/Procedures200+

U-codes listed~169

Revision events (2020-2025)Multiple

Codes with special review requirement (C9757)1

Medical-Necessity Criteria — Determination for New & Emerging Technologies

Coverage Determination for New and Emerging Technologies (Non‑Medicare Members)

The following procedures and services are considered new and emerging and have unproven benefit for Non‑Medicare members:

Coverage Determination for New and Emerging Technologies (Non‑Medicare Members): Listed CPT/HCPCS/PLA/Proprietary codes and described procedures are considered new and emerging medical technologies with unproven benefit (Non‑Medicare members).

For Medicare members, Kaiser Permanente follows CMS coverage guidance; Medicare source materials prevail if conflict exists.

Coding — Grouped Code Lists and Status

Unsupported block type: object

Provider Actions — Documentation, Billing & Authorization

Documentation Required

Verify Medicare Guidance for Medicare Members

For Medicare members, consult the CMS Medicare Coverage Database and apply Medicare national/local coverage documentation when available; Medicare guidance supersedes this document when there is a conflict.

Documentation Required

Check Member Evidence of Coverage

Always consult the patient's Evidence of Coverage or call Member Services to determine coverage for a specific medical service, since member contracts differ in benefits.

Background

Clinical Review Criteria are intended to identify new and emerging medical technologies that are considered to have unproven benefit for Non‑Medicare members due to insufficient evidence to establish impact on health outcomes. Kaiser Permanente reserves the right to modify, revoke, suspend, or change any or all Clinical Review Criteria at its sole discretion at any time, with or without notice. Use of the Clinical Review Criteria or Kaiser Permanente names/marks for marketing or publicity is strictly prohibited and Kaiser Permanente may restrict use of content for marketing. Procedures and codes listed may be updated periodically and are provided to assist in administering plan benefits but do not guarantee coverage.

New and Emerging Medical Technologies: Technologies considered to have unproven benefit because current scientific evidence is not sufficient to establish impact on health outcomes (applies to Non‑Medicare members).

Revision History (Selected Events)

07/07/2020added

Document created including new codes from 04/2020 and 07/2020.

01/01/2021added

Added new codes from 10/2020 and 01/2021.

07/06/2021revised

Updated applicable coding, including new codes released 04/01/21 and 07/01/2021.

Policy Summary

PayerKaiser Permanente

PolicyNew and Emerging Medical Technologies and Procedures

Policy CodePolicy N/A

Change TypeCode additions/removals and maintenance (non‑material and one material clarification)

Effective Date

Next Review Date

Key ActionAlways consult the patient's Evidence of Coverage or call Member Services to determine coverage for a specific medical service.

On This Page

Billing Rule

Use HCPCS U-codes for proprietary lab tests

When billing for the listed proprietary laboratory tests, report the corresponding HCPCS U‑code per service as mapped in this document.

0256U
0257U
0258U
0259U
0260U
0261U
0262U
0263U
0264U
0265U
0266U
0267U
0268U
0269U
0270U
0272U
0273U
0274U
0275U
0276U
0277U
0278U
0279U
0280U
0281U
0283U
0284U
0285U
0287U
0289U
0290U
0291U
0292U
0293U
0294U
0295U
0296U
0297U
0298U
0299U
0300U
0301U
0302U
0303U
0304U
0305U
0306U
0307U
0308U
0309U
0310U
0311U
0312U
0313U
0314U
0315U
0316U
0317U
0318U
0319U
0321U
0322U
0323U
0326U
0327U
0328U
0329U
0330U
0331U
0332U
0333U
0335U
0336U
0337U
0338U
0340U
0341U
0342U
0343U
0344U
0346U
0347U
0348U
0349U
0350U
0351U
0355U
0356U
0358U
0359U
0360U
0361U
0363U
0365U
0366U
0367U
0368U
0369U
0370U
0371U
0372U
0373U
0374U
0375U
0376U
0377U
0378U
0381U
0382U
0383U
0384U
0385U
0387U
0388U
0391U
0394U
0402U
0405U
0406U
0407U
0412U
0413U
0417U
0418U
0419U
0420U
0421U
0422U
0423U
0424U

Billing Rule

List separately when indicated

Some codes are designated to be listed separately in addition to the primary procedure; append these secondary/add-on codes when appropriate per CPT/HCPCS guidance.

0427U
0599T
0649T
0628T
0630T
0676T
0678T

Billing Rule

Authorization verification

To verify authorization requirements for a specific code by plan type, use the Pre-authorization Code Check tool.

Billing Rule

Code list completeness note

Codes listed in this document may not be all-inclusive; deleted codes and codes not in effect at the time of service may not be covered.

Billing Rule

Reporting separate services

Several entries are noted as 'List separately in addition to code for primary procedure' and should be reported as add-on or secondary services when applicable.

Billing Rule

C9757 review requirement (referenced)

Code C9757 has an added review requirement: it requires a 60‑day notice review effective 9/1/2024 as noted in the revision history.

C9757 requires 60-day notice review effective 9/1/2024

06/15/2022revised

Updated codes for remote therapeutic monitoring.

10/24/2022revised

Updated applicable codes, including new codes released 01/01/22 and 04/01/22.

11/10/2022revised

Updated applicable codes including new code from 07/01/2022.

03/03/2023revised

Updated applicable codes with multiple additions including CPT codes 0332U–0354U and HCPCS A4596, C1834.

03/06/2023revised

Updated applicable codes with additional new CPT and T codes (including 0323U–0331U, 0714T–0736T and others).

07/25/2023revised

Updated new applicable codes from 01/01/2023 and 04/01/2023.

03/18/2024removed

Removed codes K1018 and K1019.

04/03/2024removed

Removed termed code 0354U.

04/16/2024revised

Updated new and termed codes effective 01/01/2024 (code list maintenance).

04/26/2024clarifiedLatest

Added operational review requirement: code C9757 requires a 60-day notice review requirement, effective 09/01/2024. (material)

07/01/2024removed

Removed code 0380U.

08/09/2024revised

Updated new and termed codes effective 01/01/2024 (quarterly/code maintenance).

09/25/2024revised

Removed CPT 0169U (addressed elsewhere) and added new applicable codes 0439U–0449U.

12/10/2024removed

Removed CPT V2525 from policy.

12/18/2024revised

Removed deleted codes and updated code list.

12/24/2024removed

Removed code 87154.

09/25/2025revised

Updated applicable codes (ongoing maintenance).