Medical Necessity Guidelines
Designed to facilitate consistent medical necessity determinations for coverage of select services and supplies where there are not CMS policies.
CCA Health Michigan, Inc., Medical Necessity Guidelines are used for requests for coverage of select medical services and supplies, such as durable medical equipment (DME), select elective surgical procedures, and other services. The guidelines are:
- Scientifically derived and evidence-based
- Developed or adopted with input and instructions from CCA Health physicians, specialty consultants, and actively practicing specialty physicians
- Developed in accordance with standards adopted by national accreditation organizations and regulatory and government entities
- Reviewed on an annual basis with input from appropriate actively practicing physicians and other providers
- Updated as new treatments, applications, and technologies are adopted as generally accepted professional medical practice
- Applied in a manner that considers the individual healthcare needs of the patient and characteristics of the local delivery system