State Law

Nevada Rev. Statutes-Title 57-Chapter 695G. Managed Care-General Provisions

08/15/2023 Nevada Section 695G.055

“Medically necessary” defined

Medical Necessity-Definition

“Medically necessary” means health care services or products that a prudent physician would provide to a patient to prevent, diagnose or treat an illness, injury or disease, or any symptoms thereof, that are necessary and:

1. Provided in accordance with generally accepted standards of medical practice;

2. Clinically appropriate with regard to type, frequency, extent, location and duration;

3. Not primarily provided for the convenience of the patient, physician or other provider of health care;

4. Required to improve a specific health condition of an insured or to preserve the existing state of health of the insured; and

5. The most clinically appropriate level of health care that may be safely provided to the insured.