Definition of Medical Necessity: Medical necessity is a United States legal doctrine, related to activities which may be justified as reasonable, necessary, and/or appropriate, based on evidence-based clinical standards of care. Other countries may have medical doctrines or legal rules covering broadly similar grounds. The term clinical medical necessity is also used.
Coverage for Care: Implementation of Medicare Guides
Medicare pays for items and services that are "reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member." (click here for more Medicare information)
Medicare has a number of policies that describe coverage criteria. In a very few cases, Medicare may determine coverage should be based on individual cases and not general acceptance. Even in individual cases of services being deemed "reasonable and necessary," coverage may be limited due to Medicare coverage policies for frequency.
Passport health can help with services or items reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member Medical Necessity Blog Post of the Month
- Medical Necessity Definitions
- More Medical Necessity Information
March 2, 2012
Exclusion of Medical Necessity Defense to Charge of Failing to Report to BOP Upheld
by Shari Allison
The 10th upholds the refusal to admit evidence to support a medical necessity defense to a charge of failure to report to BOP following sentencing. (Full Story)