How do I determine whether the item/service provided to my Medicare patient is reasonable and necessary
Per the Medicare Program Integrity Manual, to be reasonable and necessary, an item/service must meet the following criteria:
Should be safe and effective
Should not be experimental or investigational
Should be appropriate, including the duration and frequency and provided in accordance with accepted standards of medical practice for the diagnosis or treatment of the beneficiary's condition or to improve the function of a malformed body member
Should be furnished in a setting appropriate to the beneficiary's medical needs and condition
Should be ordered and furnished by qualified personnel
Should meet but not exceed, the beneficiary's medical need
