NC medically necessary definition - Magellan Provider
[Pages:1]North Carolina Definition of Medically Necessary Services or Supplies
N.C. Gen. Stat. ? 58-50-61 "Medically Necessary Services or Supplies: Those Covered Services, including professional services or supplies which are: (a) provided for the diagnosis, treatment, cure, or relief of a health condition, illness, injury, or disease; and, except as allowed under G.S. 58-3-255, not for experimental, investigational, or cosmetic purposes; (b) necessary for and appropriate to the diagnosis, treatment, cure or relief of a health condition, illness, injury, disease, or its symptoms; (c) within generally accepted standards of medical care in the community; and (d) not solely for the convenience of the Member, the Member's family or Provider."
2/08 (last reviewed 11/21)
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