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Home > Glossary > medically necessary

medically necessary

What does medically necessary mean?

medically necessary infographic

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

Related Articles

detailed explanation of non-coverage (DENC)

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)

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.

Footnotes

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