medically necessary


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Related to medically necessary: medically necessary care

medically necessary

A covered health service or treatment that is mandatory to protect and enhance the health status of a patient, and could adversely affect the patient’s condition if omitted, in accordance with accepted standards of medical practice.

When applied to hospitalisation, medically necessary means that a plan member’s acute care needs are such that he or she cannot receive safe and adequate care as an outpatient or at a lower level of care.

Medically necessary, criteria 
A. Appropriate for the symptoms and diagnosis or treatment of a condition, illness or injury.
B. Provides for the diagnosis or direct care and treatment of the condition, illness or injury.
C. In accordance with the standards of good medical practice in the service area.
D. Not primarily for the convenience of a plan member or a plan provider. 
E. The most appropriate level or type of service or supply that can safely be provided to the plan member.

medically necessary

Managed care adjective Referring to a covered service or treatment that is absolutely necessary to protect and enhance the health status of a Pt, and could adversely affect the Pt's condition if omitted, in accordance with accepted standards of medical practice. See Futility.
Medically necessary, criteria  
a. Appropriate for the Sx and diagnosis or treatment of a condition, illness or injury
b. Provided for the diagnosis or the direct care and treatment of the condition, illness or injury
c. In accordance with the standards of good medical practice in the service area
d. Not primarily for the convenience of a plan member or a plan provider
e. The most appropriate level or type of service or supply which can safely be provided to the plan member

med·i·cal·ly ne·ces·sary

(med'i-kăl-ē nes'ĕ-sar-ē)
Services or supplies needed for diagnosis, treatment, or care.

Patient discussion about medically necessary

Q. is it ok to use drugs for medical reasons? and who is to decide when is necessary to use drugs when needed?

A. Today the most used "medical" drugs are narcotics- for pain relief, for patients who suffer extreme pain. All sorts of Codaine and Morphine types are used and on a very wide basis, and they are specially perscribed for ones who need them.

More discussions about medically necessary
References in periodicals archive ?
Amputees who don't walk with what CMS subjectively describes as 'a normal gait' or those amputees who use a cane or crutches instead of putting on their prostheses when they get up in the middle of the night are defined by CMS as having a prosthesis that's not medically necessary, and therefore the costs for which aren't covered.
They say an earlier lawsuit the state settled in 2005 compels Texas to provide "all medically necessary services" to Medicaid enrollees, including speech, physical and occupational therapy.
On review, the denial was subsequently upheld because "Air Ambulance transportation from hospital to hospital is not covered under the plan, and any other transportation must be medically necessary.
Following Brett's argument, because the additional two days of personal care services, which were provided by her daughter were medically necessary but not covered in her Choices plan, they were deductible despite the fact that they might be covered if she made a request for them.
The odds of receiving a blood transfusion were greater among women who had had an assisted vaginal delivery, who had undergone a medically necessary cesarean section before labor or who had had an elective cesarean delivery during labor (odds ratios, 2.
But "CMS orally instructed [the auditors] to deviate from written policies by (I) making determinations based primarily on the limited medical records available from suppliers, (2) applying clinical inference when reviewing supplier medical records to reasonably infer that the [equipment] provided was medically necessary, and (3) not counting lack of proof of delivery as an error if that was the only issue with a claim.
The TSA says that the introduction of lanes to serve as both family lanes and dedicated lanes for passengers carrying medically necessary liquids strengthens its efforts to build a network of technology to detect liquid explosives.
Medicare does not cover medically necessary food products and generally does not cover self-administered drugs, which include most drugs taken by IBD patients.
The second issue is whether the service is medically necessary.
All bills exempt medically necessary procedures or reconstructive work needed after disfiguring diseases, accidents or birth defects.
The court noted that the prisoner showed that the liver transplant was medically necessary, that he was eligible for a transplant, that security concerns would not bar him from being considered for a transplant, and that the transplant was not too costly.
Switching to the pump method is medically necessary if residents experience complications associated with gravity- or syringe-feeding methods.

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