Medicare Rules For Experimental or Investigational Services

CodeCast | Medical Billing and Coding Insights

Medical necessity is defined as services that are reasonable and necessary for diagnosis or treatment of an illness or injury, or to improve the functioning of a malformed body member and are not excluded under another provision of the Medicare Program.

Unfortunately, we have many practices trying to slide under the radar the experimental and/or investigational services that are considered not medically necessary or a covered benefit under most payers. Terry discusses the ins and outs of this practices and how to make sure you are not falling into a false claim trap.

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