Medical Policies 

Clicking the links below will take you away from the Patrius Health website to other sites. These sites are not the responsibility of, or under the control of, Patrius Health.

National Coverage Determinations

Refer to the following to search for National Coverage Determinations:
 

• CMS National Coverage Database

Local Coverage Determinations

Refer to the following Local Coverage Determination sites:
 

• Novitas Solutions
   
• CIGNA Government Services DME MAC Jurisdiction C Local Coverage Determinations
   
• Palmetto GBA RHHI Local Coverage Determinations

Reasonable and Necessary Guidelines

In the absence of a Local Coverage Determination, National Coverage Determination, or the Centers for Medicare & Medicaid Services Manual Instruction, reasonable and necessary guidelines still apply. Refer to Medicare Program Integrity Manual Publication 100-08, Chapter 3, Section 3.6.2.2.

There are several exceptions to the requirement that a service be reasonable and necessary for diagnosis or treatment of illness or injury in order to be considered for payment. The exceptions appear in the full text of Title XVIII Section 1862(a)1(A) of the Social Security Act.