“Medically necessary” means health care services or products that a prudent physician would provide to
a patient to prevent, diagnose or treat an illness, injury or disease, or any symptoms
thereof, that are necessary and:
1. Provided in accordance with generally accepted standards of medical practice;
2. Clinically appropriate with regard to type, frequency, extent, location and duration;
3. Not primarily provided for the convenience of the patient, physician or other provider
of health care;
4. Required to improve a specific health condition of an insured or to preserve the
existing state of health of the insured; and
5. The most clinically appropriate level of health care that may be safely provided
to the insured.
FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature or via Westlaw before relying on it for your legal needs.
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