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Medical Necessity in fee for service Pennsylvania Medical Assistance
- A service is medically necessary if it is
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.
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
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