Physician Specialty Society recommendations. Standards that are based on credible scientific evidence published in peer-reviewed, medical literature generally recognized by the relevant medical community. Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient's illness, injury, or diseaseįor these purposes, "generally accepted standards of medical practice" means:. Not primarily for the convenience of the patient, health care provider, or other physicians or health care providers. 
Clinically appropriate, in terms of type, frequency, extent, site, and duration, and considered effective for the patient's illness, injury, or disease. 
In accordance with the generally accepted standards of medical practice.For the purpose of evaluating, diagnosing, or treating an illness, injury, disease, or its symptoms."Medically Necessary" or "Medical Necessity" means health care services that a physician, exercising prudent clinical judgment, would provide to a patient. Cigna's Definition of Medical Necessity for Physicians Health Care for Seniors Definition of Medical Necessity for other Health Care Providersįull descriptions of each are given below.Health Care for Seniors Definition of Medical Necessity for Physicians.Medical Necessity for other Health Care Providers.
Cigna defines Medical Necessity in the following four ways:
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