Guidelines for Medical Necessity Determination

Guidelines for Medical Necessity Determination Overview

The MassHealth Guidelines for Medical Necessity Determination (Guidelines) are used by MassHealth's reviewing clinicians to determine the medical necessity of prior-authorization requests submitted by providers.

Guidelines for Medical Necessity Determination: Email Notification

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Guidelines for Medical Necessity Determination for Absorbent Products

Guidelines for Medical Necessity Determination for Bariatric Surgery

Guidelines for Medical Necessity Determination for Breast Reconstruction

Guidelines for Medical Necessity Determination for Breast Reduction

Guidelines for Medical Necessity Determination for Cranial Orthoses

Guidelines for Medical Necessity Determination for Enteral Nutrition Products

Guidelines for Medical Necessity Determination for Mastectomy for Gynecomastia

Guidelines for Medical Necessity Determination for Occupational Therapy

Guidelines for Medical Necessity Determination for Organ Transplant Procedures

Guidelines for Medical Necessity Determination for Panniculectomy

Guidelines for Medical Necessity Determination for Physical Therapy

Guidelines for Medical Necessity Determination for Speech and Language Therapy

Guidelines for Medical Necessity Determination for Standers

Guidelines for Medical Necessity Determination for Support Surfaces

Medical Necessity Review Forms

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