Background

20.1.1 - Background (Rev. 10438, Issued: 11-06-20, Effective: 03-01-20, Implementation: 01- 11-21) In enacting the Medicare program, Congress recognized that the physician or allowed practitioner would play an important role in determining utilization of services. The law requires that payment can be made only if a physician or allowed practitioner certifies the need for services and establishes a plan of care. The Secretary is responsible for ensuring that Medicare covers the claimed services, including determining whether they are "reasonable and necessary."