405 IAC 5-2-17 "Medically necessary service" defined

Sec. 17. "Medically necessary service" as used in this title means a covered service (as defined in section 6 of this rule) that is required for the care or well-being of the patient and is provided in accordance with generally accepted standards of medical or professional practice. For a service to be reimbursable by the office, it must: (1) be medically necessary, as determined by the office, which shall, in making that determination, utilize generally accepted standards of medical or professional practice; and (2) not be listed in this title as a noncovered service, or otherwise excluded from coverage.