Clinical Review Criteria Total Hip Arthroplasty
Defines Kaiser Permanente Washington clinical review and medical necessity criteria for total hip arthroplasty (including inpatient vs ambulatory level of care, indications such as degenerative hip disease, avascular necrosis, inflammatory arthritis, revisions, and contraindications), required documentation, and applicable CPT codes.
MPC approved updates to the documentation requirements for Arthritis, Degenerative Disease section effective 01/01/2026 (60-day notice).
MPC approved to adopt medical necessity criteria for Total Hip Arthroplasty for non-Medicare, effective 06/01/2023.
Clarified Level of Care Requirement for Medicare and Non-Medicare Members (05/16/2023).
Added clarification on Medicare IPO list update effective 01/01/2022 (02/06/2023).
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.