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Medical Necessity

Meaning

Medical Necessity is a clinical and legal concept defining healthcare services or supplies that a prudent physician would provide to a patient for the purpose of preventing, diagnosing, or treating an illness, injury, disease, or its symptoms in a manner that is consistent with generally accepted standards of medical practice. In the hormonal health space, a treatment is deemed medically necessary when it addresses a diagnosed pathology, such as hypogonadism or hypothyroidism, rather than solely for aesthetic or wellness enhancement. This determination is essential for insurance coverage and ethical clinical decision-making. The treating clinician must provide clear documentation linking the intervention to a recognized diagnosis.