Term used by insurers to describe medical treatment that is appropriate and in accordance with generally accepted standards of medical practice.

A basic criterion used by health insurance companies to determine if healthcare services should be covered. A medical service is generally considered to meet the criteria of medical necessity when it [..]

Health care services or supplies needed to diagnose, prevent or treat your condition and that meet accepted standards of medical practice.

Medical necessity is a legal concept which refers to the health care services or products provided by a physician to a patient. It is provided for the purpose of preventing, diagnosing, treating an in [..]

Health care or products that a prudent, or wise, doctor would give to a patient to prevent, diagnose, or treat an illness, injury, disease or its symptoms in a way that follows generally accepted stan [..]

This term refers to healthcare services or treatments that a patient requires to treat a serious medical condition or illness. This does not include cosmetic or investigative services.

Medical service or procedure that is performed on for treatment of an illness or injury that is not considered investigational, cosmetic, or experimental.

The purpose of Medical Necessity Criteria is to assist Care Managers (masters or doctoral level psychologists, social workers, or licensed psychiatric nurses with over five years of mental health experience) and board certified psychiatrists, during a clinical review to determine the most appropriate level of care and intensity of services and indi [..]

Legal term used to determine eligibility for health benefits and services. It describes services that are consistent with a diagnosis, meet standards of good medical practice, and are not primarily for the convenience of the patient.