Medical necessity definition

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:

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Medical necessity for inpatient care means a requested

Medical necessity means a medical condition of a pregnant woman that, in the reasonable judgment of the physician who is attending the woman, so complicates the pregnancy that it necessitates the immediate performance or inducement of an abortion.

Examples of Medical necessity in a sentence

• Implant – mandibular augmentation purposes Appliance removal – “by report” for provider that did not place appliance, splint or hardware Medical necessity must be met by demonstrating severe functional difficulties, developmental anomalies of facial bones and/or oral structures, facial trauma resulting in functional difficulties or documentation of a psychological/psychiatric diagnosis from a mental health provider that orthodontic treatment will improve the mental/psychological condition of the child.

• Medical necessity was established for the beneficiary as defined under California Code of Regulations, Title 9, Division 1, Chapter 11, for the service or services provided, for the timeframe in which the services were provided.

• Medical necessity must be established before other services can be provided.

• If Medical necessity is established the non-preferred drug copay plus the difference between the brand-name and the generic drug will apply.

• Medical necessity shall be determined at an initial assessment appointment which shall be made available within 10 business days of request.

More Definitions of Medical necessity

Medical necessity or "medically necessary" means or describes

Medical necessity for inpatient care means a requested service which is reasonably calculated to: (a) Diagnose, correct, cure, or alleviate a mental disorder or substance use disorder; or (b) prevent the progression of a mental disorder or substance use disorder that endangers life or causes suffering and pain, or results in illness or infirmity or threatens to cause or aggravate a disability, or causes physical deformity or malfunction, and there is no adequate less restrictive alternative available.

Medical necessity for inpatient care means a

Medical necessity for inpatient care of a minor means a

Medical necessity means the requirements as defined in the COUNTY MHP Medical Necessity for Medi-Cal reimbursed Specialty Mental Health Services that includes Diagnosis, Impairment Criteria and Intervention Related Criteria.

Medical necessity means determination that a specific service is medically (clinically) appropriate and necessary to meet a client’s treatment needs, consistent with the client’s diagnosis, symptoms and functional impairments and consistent with clinical Standards of Care.

Medical necessity or “medically necessary” means health care provided to correct or diminish the adverse effects of a medical condition or mental illness; to assist a client in attaining or maintaining an optimal level of health; to diagnose a condition; or to prevent a medical condition from occurring;