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Targeted review list

Targeted Review List Updates

Targeted Review List Procedure Codes

Kaiser Permanente reserves the right to add or remove from the Targeted Review List* any procedures or services deemed appropriate by the Kaiser Permanente Quality Forum Committee, Quality Resource Management (QRM), or management. QRM will strive to provide sufficient notification prior to any anticipated change. Please contact them with any questions.

All procedures or services found on the targeted review list require authorization or medical necessity review by QRM. Please submit complete supporting clinical information with all requests.

Initiate routine requests via KP Online-Affiliate by calling 404-364-7320 or 800-221-2414 (toll-free), or by faxing to 404-364-7187. STAT requests must be entered with the priority of “Urgent” in KP Online-Affiliate. All requests must include pertinent, supporting clinical indications for the requested study.

An authorization is valid when the following conditions are met:

    An approval notification has been received via KP Online-Affiliate In-Basket message, fax, or phone call from Kaiser Permanente, including the authorization number

    Services are rendered between the assigned start date and expiration date of the authorization to the specialist or facility, as noted on the authorization

    Member has the appropriate benefit and is eligible on the date of service

    Procedure or treatment is medically necessary for the member’s diagnosis

    Procedure or treatment is performed in a practitioner’s office, outpatient hospital, or ambulatory surgery center

Kaiser Permanente reserves the right to close an authorization prior to its expiration date.

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