Not medically necessary definition

Not medically necessary means an item or service which is not consistent with the
Sample 1

Examples of Not medically necessary in a sentence

  • Not medically necessary services—with the exception of preventive services.

  • Cosmetic Not medically necessary Up to $130 allowance (member responsible for any cost exceeding the allowance) Includes contact lens fitting and suitability exam.

  • If the contractor cannot authorize the care because the care is not medically necessary, the contractor will include **Not medically necessary.

  • If any claim determination made by us meets one or more of the following conditions: • Not medically necessary • Cosmetic • Experimental or investigational treatment • Requires medical judgment then the appeal of the claim determination must include an Independent Review Organization (IRO) report that includes each panel member’s report and the panel’s consensus report.

  • Plaintiffs also challenge Commerce’s finding that their outlets and BWPFs have similar physical characteristics even though their outlets are imported under a separate HTSUS subheading from BWPFs. See Remand Results at 54.

  • CODES CodesNumberDescriptionCPT83090HomocysteineHCPCS ICD-10-CM Not medically necessary for all cardiovascular disease codes and investigational for venous thromboembolic disorder codes.

  • Otherwise, the RVSR carefully reviews all the medical evidence, applies the policies set forth in federal regulations32 to determine entitlement to each issue claimed, and documents the results in a rating decision.

  • If we do not decide your Plan Appeal on time, and we said the service you are asking for is:1) Not medically necessary; 2) Experimental or investigational; 3) Not different from care you can get in the plan’s network; or 4) Available from a participating provider who has correct training and experience to meet your needs, the original denial will be reversed.

  • If, for example, the contractor cannot authorize the care it is not a benefit under the Uniform HMO Benefit, the contractor will include *”Not a benefit.” If the contractor cannot authorize the care because the care is not medically necessary, the contractor will include **Not medically necessary.

  • If, for example, the contractor cannot authorize the care it is not a benefit under the Uniform HMO Benefit, the contractor will include *”Not a benefit.” If the contractor cannotauthorize the care because the care is not medically necessary, the contractor will include **Not medically necessary.

Related to Not medically necessary

  • Medically Necessary means a service which is appropriate and consistent with the treatment of the condition in accordance with accepted standards of community practice.

  • Medically necessary care means care that is (1) appropriate and consistent with and essential for the prevention, diagnosis, or treatment of a Patient’s condition; (2) the most appropriate supply or level of service for the Patient’s condition that can be provided safely; (3) not provided primarily

  • Medically Necessary Services means those covered services that are, under the terms and conditions of the contract, determined through contractor utilization management to be:

  • Medically fragile means the condition of a child who requires the availability of twenty-four-hour skilled care from a health care professional or specially trained staff or volunteers in a group care setting. These conditions may be present all the time or frequently occurring. If the technology, support and services being received by the medically fragile children are interrupted or denied, the child may, without immediate health care intervention, experience death.

  • Medically Necessary Treatment means any treatment, tests, medication, or stay in hospital or part of a stay in hospital which:

  • Medically Necessary Leave of Absence means any change in enrollment at the post-secondary school that begins while the child is suffering from a serious illness or injury, is medically necessary, and causes the child to lose student status for purposes of coverage under the Plan.

  • Medically Fit to Travel means based on assessment a Legally Qualified Physician has advised You, a Traveling Companion, Family Member or Business Partner booked to travel with You in writing that there is no medical condition, illness, Injury or Sickness that would likely interfere with a Trip at the time of purchase of Coverage for a Trip.

  • Primary care giver" means a person who assumes the principal role of providing care and attention to a child.

  • Technically Feasible refers solely to technical or operational concerns, rather than economic, space, or site considerations.

  • Medically Appropriate means services and medical supplies required for prevention, diagnosis, or treatment of a physical or behavioral health condition or injuries that are:

  • Medical home means a team approach to providing health care that originates in a primary care setting; fosters a partnership among the patient, the personal provider, and other health care professionals, and where appropriate, the patient’s family; utilizes the partnership to access and integrate all medical and nonmedical health-related services across all elements of the health care system and the patient’s community as needed by the patient and the patient’s family to achieve maximum health potential; maintains a centralized, comprehensive record of all health-related services to promote continuity of care; and has all of the characteristics specified in section 135.158.

  • Medically accurate means verified or supported by research conducted in compliance with scientific methods and published in peer-reviewed journals, where appropriate, and recognized as accurate and objective by professional organizations and agencies with expertise in the relevant field, such as the federal Centers for Disease Control and Prevention, the American Public Health Association, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists.

  • Hospice means a public agency or private organization licensed pursuant to Chapter 400, Florida Statutes, to provide Hospice services. Such licensed entity must be principally engaged in providing pain relief, symptom management, and supportive services to terminally ill Members and their families.

  • Elderly means Elderly as defined in Section 420.503, F.S.

  • DME means durable medical equipment, which is an item or appliance that can withstand repeated use, is designed to serve a medical purpose, and is not generally useful to a person in the absence of a medical condition, illness, or injury.

  • Primary care-giver means a person who assumes the principal role of providing care and attention to a child.

  • Primary caregiver or "caregiver" means a resident of the State

  • Home health aide services means the personal care and maintenance activities provided to individuals for the purpose of promoting normal standards of health and hygiene.

  • Nutrient management plan means a plan developed or approved by the Department of Conservation and Recreation that requires proper storage, treatment and management of poultry waste, including dry litter, and limits accumulation of excess nutrients in soils and leaching or discharge of nutrients into state waters.

  • Preventive services means preservation services, as defined

  • Behavioral health services means mental health services as

  • Behavioral health provider means a person licensed under 34 chapter 18.57, 18.57A, 18.71, 18.71A, 18.83, 18.205, 18.225, or 18.79

  • Community mental health program means all mental health

  • Behavioral health treatment means counseling and treatment programs, including applied behavior analysis, that are:

  • Telehealth services means the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient's health care while the patient is at the originating site and the provider for telehealth is at a distant site. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers.

  • Telehealth means the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-managements of a patient’s health care while the patient is at the originating site and the health care provider is at a distant site. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers.