Medically necessary service definition

Medically necessary service means a medical, surgical, or other services required for the prevention, diagnosis, cure, or treatment of a health- related condition including any such services that are necessary to slow or prevent a decremental change in medical and/or mental health status.

Medically necessary service means that:

Medically necessary service means a covered service that, in a manner consistent with accepted standards of medical practice, is reasonably expected to:

Examples of Medically necessary service in a sentence

• Medically Necessary or Medical Necessity means Medically Necessary Service as defined by Utah Administrative Code R414-1-2.

• The Parties acknowledge and agree, subject to Section 4.11, that it shall be in the Provider’s sole discretion to determine whether or not any Covered Service is a Medically Necessary Service.

• If at any time during an Episode of Care, a Provider determines that any Medically Necessary Service must be performed on an urgent or emergency basis to preserve the life or health of the Participant, Sponsor will be responsible for payment of the Provider’s charges for any such Medically Necessary Service as part of the Episode of Care.

• Sponsor acknowledges and agrees that any of the following shall be billed by Providers to a Participant and/or the Plan, as applicable, through the Plan Administrator: (a) certain medical consultations and certain diagnostic testing provided in advance of a medical procedure to determine whether or not such procedure is a Medically Necessary Service; (b) Convenience Items; and (c) any medical procedure or medical care that is not a Medically Necessary Service.

• Medically Necessaryor Medical Necessity means Medically Necessary Service as defined by Utah Administrative Code R414-1-2(18).

More Definitions of Medically necessary service

Medically necessary service means a covered dental service, requested by specialty care referral, which is: (1) adequate, appropriate and essential for the evaluation, diagnosis and treatment of a dental condition or disease; and (2) consistent with nationally accepted standards of practice.

Medically necessary service means a service or treatment that is absolutely necessary to treat or diagnose a patient and could adversely affect the patient’s condition, illness or injury if it were omitted, and the service or treatment is not considered an elective or cosmetic surgery service or treatment.

Medically necessary service means a health care item or service which a Provider determines to be both reasonable and necessary to diagnose or treat an illness, injury, condition, disease or symptom of a Participant which is consistent with accepted standards of medicine.

Medically necessary service means any inpatient or outpatient service, including pharmaceuticals or supplies provided by the hospital to a patient covered under Title XVII of the Federal Social Security Act for beneficiaries with the same clinical presentation as the uninsured patient. A Medically Necessary service does not include: (1) non-medical services such as social or vocational services; (2) Elective self-pay packages as defined by Self-Pay Package policies, or(3) elective cosmetic surgery (exclusive of plastic surgery designed to correct disfigurement cause by injury, illness or congenital defect or deformity).

Medically necessary service means a service or item reimbursable under the Montana Medicaid program, as provided in ARM 37.82.102:

Medically necessary service means a service or treatment that is absolutely necessary to treat or diagnose a patient and could adversely affect the patient's condition, illness or injury if it were omitted.

Medically necessary service or “Medically Necessary” means those Covered Services that are within generally accepted standards of medical care in the State community, as verified by independent Medicaid consultants, and not experimental in nature.