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Home > Glossary > medically necessary

medically necessary

What does medically necessary mean?

Medically necessary refers to services or supplies that are necessary for the diagnosis or treatment of a medical condition.¹

Medicare will only cover medically necessary care, and has an evidence-based process for setting coverage rules to ensure that medically necessary care is covered.²

Footnotes

”What Is Medical Necessity?” National Association of Insurance Commissioners. Accessed May 22, 2025 ⤶
”Medicare Coverage Determination Process” Centers for Medicare & Medicaid Services. Accessed May 22, 2025 ⤶

detailed explanation of non-coverage (DENC)

When a provider – a home health agency, or skilled nursing facility, or other agency – determines you are no longer eligible for Medicare services, you will receive a detailed explanation of non-coverage.

detailed explanation of non-coverage (DENC)

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medically necessary

What does medically necessary mean?

What does medically necessary mean?

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