IC 27-1-37.5-5.4 — "Medically necessary"
Chapter 37.5. Health Care Service Prior Authorization
Bills citing this section
Section text
Sec. 5.4. As used in this chapter, "medically necessary" means a health care service that a prudent health care provider would provide to a patient for the purpose of preventing, diagnosing, or treating an illness, injury, disease, or symptoms in a manner that is: (1) in accordance with generally accepted standards of medical practice; (2) clinically appropriate in terms of type, frequency, extent, site, and duration; and (3) not primarily for: (A) the economic benefit of the health plan or purchaser; or (B) the convenience of the health plan, patient, treating physician, or other health care provider.
As added by P.L.144-2025, SEC.13.
Source: official publisher (2026 edition)