Shoulder arthroplasty (total, reverse, hemiarthroplasty, and revisions)
Clinical review criteria governing medical necessity determinations and prior authorization/site-of-service review for shoulder arthroplasty procedures for Kaiser Foundation Health Plan of Washington and Kaiser Foundation Health Plan of Washington Options, Inc. Applies to Medicare and non‑Medicare members covered by these Kaiser Permanente entities.
Kaiser Permanente approved adoption of hybrid MCG criteria KP-S-634 (Shoulder Arthroplasty) and KP-S-633 (Shoulder Hemiarthroplasty) for Medicare and Non‑Medicare members.
Medical Necessity Criteria for Shoulder Arthroplasty
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.