Medicare Benefit Policy Manual (Pub. 100-02), Ch. 15 § 80.5.2
Authority
80.5.2 - Authority
(Rev. 70, Issued: 05-11-07, Effective: 01-01-07, Implementation: 07-02-07)
Definitions can be found in sections 1861(s)(15) and (rr)(1) of the Social Security Act (the Act). Conditions
for coverage and frequency standards can be found in 42 CFR 410.31. Denials as not reasonable and
necessary can be found at §1862(a)(1)(A) of the Act, 42 CFR 410.31(e), and 42 CFR 411.15(k).