Kaiser Permanente Prior Authorization Lookup
- Kaiser Permanente coverage criteria
- Kaiser Permanente contact directory
- All Kaiser Permanente policy updates
Latest Kaiser Permanente prior authorization updates15
- Prior AuthClinical/Medical PolicyEff. 2026-04-01Ambulatory Surgery Center (ASC) - Site of Care PolicyDefines Kaiser Permanente Washington requirements for prior authorization and medical necessity review of outpatient surgical site-of-care (ASC vs hospital outpatient/inpatient) for specified counties and procedure groups; affects providers performing GI, general surgery, plastic, orthopedic/podiatry procedures and Kaiser members in the listed counties.All Kaiser Permanente updates
- Prior AuthClinical/Medical PolicyEff. 2024-11-01Shoulder 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.All Kaiser Permanente updates
- Prior AuthClinical/Medical PolicyEff. 2024-03-01Clinical Review Criteria: Applied Behavioral Analysis (ABA) TherapyClinical review criteria governing preauthorization, provider qualifications, documentation, and medical necessity determinations for ABA therapy for Kaiser Foundation Health Plan of Washington members (non‑Medicare and Medicare sections noted). Applies to providers requesting ABA benefits under Kaiser Permanente WA plans.All Kaiser Permanente updates
- Prior AuthClinical/Medical PolicyEff. 2024-01-21Clinical Review Criteria — AcupunctureClinical review criteria that govern when acupuncture is considered medically necessary, prior authorization requirements, provider credentialing, and Medicare-specific limits for Kaiser Foundation Health Plan of Washington members.All Kaiser Permanente updates
- Prior AuthClinical/Medical PolicyEff. 2023-12-01Clinical Review Criteria — Elective Surgical Procedures (Level of Care Policy)Governs prior authorization and level-of-care determinations for a wide range of elective surgical procedures for Kaiser Foundation Health Plan of Washington members, specifying when inpatient versus outpatient/ASC settings require additional review and documentation.All Kaiser Permanente updates
- Prior AuthClinical/Medical PolicyEff. 2023-09-05Clinical Review Criteria — Sinus Surgeries: Sinuplasty, Functional Endoscopic Sinus Surgery (FESS), SeptoplastyClinical review criteria governing medical necessity determinations and preauthorization requirements for sinuplasty, FESS, and septoplasty for Kaiser Foundation Health Plan of Washington members and their providers.All Kaiser Permanente updates
- Prior AuthClinical/Medical PolicyEff. 2023-08-01Clinical Review Criteria — Shoulder ArthroplastyClinical review criteria governing medical necessity determinations for shoulder arthroplasty procedures for Kaiser Foundation Health Plan of Washington members (Medicare and Non‑Medicare), including eligibility criteria, optimization requirements, and required documentation for prior authorization.All Kaiser Permanente updates
- Prior AuthClinical/Medical PolicyEff. 2023-02-13general_anesthesia_for_dental_procedures_policyDefines coverage for general anesthesia and facility charges for dental procedures when medically necessary under specified member conditions and subject to prior authorization and designated facility requirements. Dental procedure fees themselves are excluded.All Kaiser Permanente updates
- Prior AuthClinical/Medical PolicyEff. 2021-07-01Site-of-care prior authorization for selected outpatient surgical procedures (Gastroenterology and related specialties)Defines prior authorization and site-of-care medical necessity criteria for selected elective outpatient surgical procedures (notably GI, general surgery, and plastic surgery) in specified Washington counties, affecting Kaiser Permanente providers and members.All Kaiser Permanente updates
- Prior AuthClinical/Medical PolicyEff. 2020-01-21Acupuncture — Coverage Criteria for Chronic Low Back PainClinical review criteria governing coverage and prior authorization for acupuncture services for Kaiser Foundation Health Plan of Washington members, including Medicare and non-Medicare members; affects ordering providers, acupuncturists, and reviewers.All Kaiser Permanente updates
- Prior AuthClinical/Medical PolicyEff. 2007-04-19Wearable_Auto_DefibrillatorClinical review criteria for automated external defibrillators (AEDs) for home use in pediatric patients and wearable cardioverter defibrillators (WCD/WAD) for adults, including coverage guidance, background, evidence conclusions, applicable HCPCS codes, and a revision reinstating prior authorization for non‑Medicare members effective 2026-08-01.All Kaiser Permanente updates
- Prior AuthAdministrative/Operational Policy2025 PPO preauthorization and notification requirementsLists services that require notification or preauthorization for Kaiser Permanente Washington PPO members and explains where members and providers can verify requirements; affects members, providers, and billing/authorization staff in Washington.All Kaiser Permanente updates
- Prior AuthClinical/Medical PolicyMyocardial Perfusion Imaging (Exercise and Pharmacologic Nuclear Stress Tests) — Clinical Review CriteriaClinical review criteria governing medical necessity review and preauthorization guidance for myocardial perfusion imaging (exercise and pharmacologic nuclear stress tests) for Kaiser Foundation Health Plan of Washington members and providers.All Kaiser Permanente updates
- Prior AuthClinical/Medical PolicyNew and Emerging Medical Technologies and Procedures (clinical review criteria)Clinical review criteria governing new and emerging medical technologies and procedures for Kaiser Foundation Health Plan of Washington members and their providers; distinguishes guidance for Medicare and non‑Medicare members. Applies to internal use by Kaiser Permanente Washington and affects coverage determinations and prior authorization processes.All Kaiser Permanente updates
- Prior AuthReimbursement/Payment PolicyPediatric Cardiology — Procedure Standard Code Ranges and Prior Authorization GuidanceDefines procedure code ranges, consultation visit types, and tools for verification and prior authorization for pediatric cardiology services provided by Kaiser Foundation Health Plan of Washington and its Options, Inc. plan; applies to contracted and non-contracted providers interacting with this payer.All Kaiser Permanente updates
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Tool Description
Search Kaiser Permanenteprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
FAQ
Type a drug name (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee”), or a policy title into the search bar. Filter results by payer, specialty, policy type, or effective year. Open any result for the full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
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Prior auth requirements change all the time. Keep up with every payer policy update in the live policy feed, or browse payers with prior authorization policies.
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