Clinical necessity definition

Clinical necessity or "medical necessity" shall mean services provided by a facility or providers that are required to identify or treat individuals or groups of patients and are: (A) consistent with the symptoms or diagnosis and treatment of the patient's condition, disease, ailment, or injury, and (B) appropriate with regard to standards of good professional practice, and (C) not solely for the convenience of a patient, provider, or facility, and (D) the most appropriate level of service which can safely be provided to the patient. When applied to the care of an inpatient, it further means that services for the patient's clinical or medical symptoms or condition require that the services cannot be safely provided to the patient as an outpatient.
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Clinical necessity or "medical necessity" means services provided by a facility or providers that are required to identify or treat individuals or groups of patients and are:
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Related to Clinical necessity

  • Medical necessity means that the service or supply is provided by a physician or other health care provider exercising prudent clinical judgment for the purpose of preventing, evaluating, diagnosing or treating an illness, injury or disease or its symptoms, and that provision of the service or supply is:

  • Clinical nurse specialist means a registered nurse with relevant post-basic qualifications and 12 months’ experience working in the clinical area of his/her specified post-basic qualification, or a minimum of four years’ post-basic registration experience, including three years’ experience in the relevant specialist field and who satisfies the local criteria.

  • Corrective Measure means a measure as defined in Article 3, point 16, of Regulation (EU) 2019/1020;

  • Licensed practical nurse means a person licensed as a trained practical nurse under ch. 441, Stats.

  • Mobile crisis outreach team means a crisis intervention service for minors or families of minors experiencing behavioral health or psychiatric emergencies.