Kaiser Permanente Clinical Review Criteria for Bone Lengthening
Clinical review criteria governing medical necessity determinations for bone lengthening procedures for Kaiser Foundation Health Plan of Washington members (Medicare and non-Medicare), including indications, exclusions, required documentation, and applicable CPT/HCPCS codes. Medicare members use non-Medicare criteria in absence of NCD/LCD guidance.
MPC approved to adopt criteria for Bone Lengthening for Medicare and Non-Medicare members.
Coverage Summary
Clinical review criteria governing medical necessity determinations for bone lengthening procedures for Kaiser Foundation Health Plan of Washington members (Medicare and non-Medicare), including indications, exclusions, required documentation, and applicable CPT/HCPCS codes. Medicare members use non-Medicare criteria in the absence of an active NCD/LCD; Kaiser applies its own criteria for Medicare members when no Medicare coverage guidance exists. Coverage stance: mixed. Effective date: 2024-09-01; Last review: 2024-09-03; Next review: 2025-09-02.