Medical Necessity

NCCHC’s definition is based on the same assumptions the standards themselves are founded on; namely, a clinical decision by a qualified health practitioner based on clinical judgment in keeping with current community standards of practice to meet a serious health need of the individual in question. This does not mean that every medical request must be answered in the manner the patient desires, but that each request must be evaluated by the appropriate clinician. Procedures considered elective or experimental and those for cosmetic rather than functional reasons generally are not considered medical necessities. The qualified clinician making this clinical determination should document the decision and steps taken to arrive at it in the medical record of the individual involved.

— From CorrectCare Volume 16, Issue 4, Fall 2002