Medically Necessary Definition Virginia

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12VAC5-408-10. Definitions. - Virginia

https://law.lis.virginia.gov/admincode/title12/agency5/chapter408/section10/

"Medical necessity" or "medically necessary" means appropriate and necessary health care services which are rendered for any condition which, according to generally accepted principles of good medical practice, requires the …

Medical Necessity Definition in Health Insurance

https://www.verywellhealth.com/medical-necessity-1738748

Medical necessity refers to a decision by your health plan that your treatment, test, or procedure is necessary to maintain or restore your health or to …

State Definitions of Medical Necessity under the Medicaid EPSDT …

https://nashp.org/state-definitions-of-medical-necessity-under-the-medicaid-epsdt-benefit/

For purposes of the administration of the medical assistance programs by the Department of Social Services, “medically necessary” and “medical necessity” mean those health …

What Is Medical Necessity? - National Association of …

https://content.naic.org/sites/default/files/consumer-health-insurance-what-is-medical-necessity.pdf

Medicare defines “medically necessary” as health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet …

Medical Necessity Definitions | Cigna

https://www.cigna.com/health-care-providers/coverage-and-claims/policies/medical-necessity-definitions

"Medically Necessary" or "Medical Necessity" means health care services that a physician, exercising prudent clinical judgment, would provide to a patient. The service …

Magellan Medical Necessity Criteria - Magellan of Virginia

https://www.magellanofvirginia.com/documents/2021/11/magellan-medical-necessity-criteria.pdf/

TERMS & DEFINITIONS Medical Necessity Services by a provider to identify or treat an illness that has been diagnosed or suspected. The services are: • Consistent with the …

What Does Medically Necessary Mean in Medicare?

https://www.ehealthinsurance.com/medicare/coverage/medically-necessary-definition/

“Medically necessary” is a standard that Medicare uses when deciding whether to cover a health-care service or item. This applies to everything from flu shots …

“Medically Necessary” Defined - AgingInPlace.org

https://aginginplace.org/finance-legal/medically-necessary-defined/

A “medical necessity” can be an overarching term to describe something that is absolutely needed to help someone survive or get better. In terms of …

§ 38.2-3412.1. Coverage for mental health and …

https://law.lis.virginia.gov/vacode/title38.2/chapter34/section38.2-3412.1/

Up to 10 days of the inpatient benefit set forth in subdivisions 1 and 2 of this subsection may be converted when medically necessary at the option of the person or the parent, as …

Code of Virginia Code - Chapter 21.1. Medical Malpractice

https://law.lis.virginia.gov/vacodefull/title8.01/chapter21.1/

Definitions. As used in this chapter: "Health care" means any act, professional services in nursing homes, or treatment performed or furnished, or which should have been …

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