According to the Medicare Program Integrity Manual, a service is considered reasonable and necessary if it is:
- safe and effective
- not experimental or investigational (exception Qualifying Clinical Trials services)
- appropriate in duration and frequency
- furnished in an appropriate setting
- ordered and/or furnished by qualified personnel
- one that meets but does not exceed the patient's medical needs, and
- at least as beneficial as an existing and available medically appropriate alternative.
Submitted by YSM Web Group on July 23, 2012