Ind. Code § 27-1-37.5-5.4
This is the official text of Ind. Code § 27-1-37.5-5.4, part of Indiana’s Code — part of the compiled statutory law of Indiana, published by the state as "Code." Browse the sections below, each linked to its official government source.
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"Medically necessary"
Official statutory text
Sec. 5.4. As used in this chapter, "medically necessary" means a health care service that a prudent health care provider would provide to a patient for the purpose of preventing, diagnosing, or treating an illness, injury, disease, or symptoms in a manner that is:
(1) in accordance with generally accepted standards of medical practice;
(2) clinically appropriate in terms of type, frequency, extent, site, and duration; and
(3) not primarily for:
(A) the economic benefit of the health plan or purchaser; or
(B) the convenience of the health plan, patient, treating physician, or other health care provider.
As added by P.L.144-2025, SEC.13.
(1) in accordance with generally accepted standards of medical practice;
(2) clinically appropriate in terms of type, frequency, extent, site, and duration; and
(3) not primarily for:
(A) the economic benefit of the health plan or purchaser; or
(B) the convenience of the health plan, patient, treating physician, or other health care provider.
As added by P.L.144-2025, SEC.13.
Status: in_force · Read it on the official government site
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