cms definition of medically necessary
While âmedically necessaryâ might seem like a subjective term, it can be boiled down to a pretty simple definition. Under Medicare, a service that is âmedically necessaryâ is a service that Medicare pays for at this time for the particular diagnosis. The main terms to focus on are âat this timeâ and âdiagnosis.â Any procedure could eventually become medically necessary, for a given diagnosis, at some time in the future.