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Medical Necessity in fee for service Pennsylvania Medical Assistance
In the fee for service program, the service or item
prescribed must meet all three parts of the definition.
Cite: 55 Pa.code 1101.21
A service, item, procedure or level of care that is:
- compensable under the Medical Assistance Program
- Necessary to the proper treatment or management of an
illness, injury, or disability
- Prescribed, provided or ordered by an appropriate licensed practitioner in accordance with accepted standards of practice.
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