...Personal comfort items and senices (for example a television set, or telephone service, etc.); (k) Which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improw the functioning of a malformed bodj member (thus, payment could not be made for the rental of...

...services. (k) Any services that are not reasonable and necessary for one of the following purposes: (1) For the diagnosis or treatment of illness or injury or to improve the 1 Before July 1981. inpatient hospital care in connection with dental procedures was covered only when...

...Part A benefits, if HCFA reimburses the provider for those services. (d) Custodial care and services not reasonable and necessary for the diagnosis or treatment of illness or injury, if— (1) The beneficiary was without fault in incurring the expenses; and (2) The determination that...

...Part A benefits, if HCFA reimburses the provider for those services. (d) Custodial care and services not reasonable and necessary for the diagnosis or treatment of illness or injury, if— (1) The beneficiary was without fault in incurring the expenses; and (2) The determination that...

...beneficiaries is not reimbursable under medicare. For one thing, the law prohibits medicare payment for services which are not reasonable and necessary for the diagnosis or treatment of illness or injury. This means that sometimes a judgment must be made by our carriers with the advice of medical consultants...

...beneficiaries is not reimbursable under medicare. For one thing, the law prohibits medicare payment for services which are not reasonable and necessary for the diagnosis or treatment of illness or injury. This means that sometimes a judgment must be made by our carriers with the advice of medical consultants...

...are particularly relevant as they apply to the eye patient. These exclusions are : 1. Services not necessary for the diagnosis or treatment of illness or injury or to improve function of a malformed member. 2. Personal comfort items. 8. Cosmetic surgery (with certain exceptions)....

...most efficient use of available health facilities and services. Since the exclusion from coverage of services "which are not reasonable and necessary for the diagnosis or treatment . . ." parallels decisions on "medical necessity of services . . ." the Secretary must be given the...

...for medically necessary services. The Medicare and Medicaid statutes prohibit payment for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury. Therefore paying agents are required to establish safeguards to assure that payments — including...

...interpretation of those provisions which limit or extend benefits (eg, items and services which are reasonable and necessary for the diagnosis or treatment...illness or injury or to improve the functioning of malformed body member). Issues also arise as to the delayed determination of benefits and the scope...