What is meant by the term 'medical necessity'?

The term 'medical necessity' refers specifically to the need for healthcare services to meet established clinical standards and guidelines in order to be deemed necessary for a patient's condition. This means that for a service to qualify as medically necessary, it must be appropriate, reasonable, and adequate for the diagnosis or treatment of the patient, as well as align with accepted standards of care. Insurers and healthcare providers often use these criteria to determine coverage for specific procedures, ensuring that they are not providing unnecessary services.

Other options may have relevance in a healthcare setting, but they do not accurately capture the essence of medical necessity. For example, while documentation is important for all services, it does not inherently determine their medical necessity. Patient choice and a doctor's obligation to perform requested services may be influenced by medical necessity but do not define it.