A service that is rarely provided, unusual, variable, or new may require a special report in determining medical appropriateness of the service.

Question

Quizplus · Accepted Answer

When a service is rare, unusual, variable, or new, there may not be enough established guidelines or evidence to determine its medical appropriateness. In such cases, a special report may be required to assess the efficacy, safety, and necessity of the service for a particular patient's condition. The report may involve a review of clinical studies, expert opinions, patient outcomes, and cost-effectiveness analyses. The purpose of the report is to provide additional information to the payer, provider, and patient to make an informed decision about the service.

A Service That Is Rarely Provided, Unusual, Variable, or New