Guidelines for Medical Necessity Determinations

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These documents were prepared for medical professionals to assist them in submitting documentation supporting the medical necessity of the proposed treatment, products, or services.

Recent Submissions

Guidelines for Medical Necessity Determination for Treatment of Varicose Veins of the Lower Extremities

MassHealth. (MassHealth, 2019-03-01)
Guidelines for Medical Necessity Determination for Support Surfaces

MassHealth. (MassHealth, 2014-11)
Guidelines for Medical Necessity Determination for Standers and Power-Assisted (Dynamic) Standing Components for Wheelchairs

MassHealth. (MassHealth, 2019-12-06)
Guidelines for Medical Necessity Determination for Speech and Language Therapy

MassHealth. (MassHealth, 2017-03-30)
Guidelines for Medical Necessity Determination for Reduction Mammoplasty

MassHealth. (MassHealth, 2019-07-24)
Guidelines for Medical Necessity Determination for Physical Therapy

MassHealth. (MassHealth, 2018-04-24)
Guidelines for Medical Necessity Determination for Orthognathic Surgery

MassHealth. (MassHealth, 2018-10-16)
Guidelines for Medical Necessity Determination for Organ Transplant Procedures

MassHealth. (MassHealth, 2019-07-03)
Guidelines for Medical Necessity Determination for Occupational Therapy

MassHealth. (MassHealth, 2018-04-13)
Guidelines for Medical Necessity Determination for Maternal Cell-Free Fetal DNA Testing for Aneuploidy

MassHealth. (MassHealth, 2020-08-11)
Guidelines for Medical Necessity Determination for Mastectomy for Gynecomastia

MassHealth. (MassHealth, 2018-10-24)
Guidelines for Medical Necessity Determination for Knee Arthroscopy

MassHealth. (MassHealth, 2018-06-01)
Guidelines for Medical Necessity Determination for Knee Arthroplasty

MassHealth. (MassHealth, 2018-06-01)
Guidelines for Medical Necessity Determination for Hospital Beds

MassHealth. (MassHealth, 2019-07-01)
Guidelines for Medical Necessity Determination for Home Health Services

MassHealth. (MassHealth, 2017-10-23)
Guidelines for Medical Necessity Determination for Genetic Testing for Hereditary Breast and/or Ovarian Cancer

MassHealth. (MassHealth, 2019-10-04)
Guidelines for Medical Necessity Determination for Gene Expression Profiling Tests for Breast Cancer

MassHealth. (MassHealth, 2016-03-15)
Guidelines for Medical Necessity Determination for Gender-Affirming Surgery

MassHealth. (MassHealth, 2019-07-31)
Guidelines for Medical Necessity Determination for Gait Trainers

MassHealth. (MassHealth, 2018-01)
Guidelines for Medical Necessity Determination for Excision of Excessive Skin and Subcutaneous Tissue

MassHealth. (MassHealth, 2017-12)

Guidelines for Medical Necessity Determinations

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Recent Submissions

Guidelines for Medical Necessity Determination for Treatment of Varicose Veins of the Lower Extremities ﻿

Guidelines for Medical Necessity Determination for Support Surfaces ﻿

Guidelines for Medical Necessity Determination for Standers and Power-Assisted (Dynamic) Standing Components for Wheelchairs ﻿

Guidelines for Medical Necessity Determination for Speech and Language Therapy ﻿

Guidelines for Medical Necessity Determination for Reduction Mammoplasty ﻿

Guidelines for Medical Necessity Determination for Physical Therapy ﻿

Guidelines for Medical Necessity Determination for Orthognathic Surgery ﻿

Guidelines for Medical Necessity Determination for Organ Transplant Procedures ﻿

Guidelines for Medical Necessity Determination for Occupational Therapy ﻿

Guidelines for Medical Necessity Determination for Maternal Cell-Free Fetal DNA Testing for Aneuploidy ﻿

Guidelines for Medical Necessity Determination for Mastectomy for Gynecomastia ﻿

Guidelines for Medical Necessity Determination for Knee Arthroscopy ﻿

Guidelines for Medical Necessity Determination for Knee Arthroplasty ﻿

Guidelines for Medical Necessity Determination for Hospital Beds ﻿

Guidelines for Medical Necessity Determination for Home Health Services ﻿

Guidelines for Medical Necessity Determination for Genetic Testing for Hereditary Breast and/or Ovarian Cancer ﻿

Guidelines for Medical Necessity Determination for Gene Expression Profiling Tests for Breast Cancer ﻿

Guidelines for Medical Necessity Determination for Gender-Affirming Surgery ﻿

Guidelines for Medical Necessity Determination for Gait Trainers ﻿

Guidelines for Medical Necessity Determination for Excision of Excessive Skin and Subcutaneous Tissue ﻿

Guidelines for Medical Necessity Determination for Treatment of Varicose Veins of the Lower Extremities

Guidelines for Medical Necessity Determination for Support Surfaces

Guidelines for Medical Necessity Determination for Standers and Power-Assisted (Dynamic) Standing Components for Wheelchairs

Guidelines for Medical Necessity Determination for Speech and Language Therapy

Guidelines for Medical Necessity Determination for Reduction Mammoplasty

Guidelines for Medical Necessity Determination for Physical Therapy

Guidelines for Medical Necessity Determination for Orthognathic Surgery

Guidelines for Medical Necessity Determination for Organ Transplant Procedures

Guidelines for Medical Necessity Determination for Occupational Therapy

Guidelines for Medical Necessity Determination for Maternal Cell-Free Fetal DNA Testing for Aneuploidy

Guidelines for Medical Necessity Determination for Mastectomy for Gynecomastia

Guidelines for Medical Necessity Determination for Knee Arthroscopy

Guidelines for Medical Necessity Determination for Knee Arthroplasty

Guidelines for Medical Necessity Determination for Hospital Beds

Guidelines for Medical Necessity Determination for Home Health Services

Guidelines for Medical Necessity Determination for Genetic Testing for Hereditary Breast and/or Ovarian Cancer

Guidelines for Medical Necessity Determination for Gene Expression Profiling Tests for Breast Cancer

Guidelines for Medical Necessity Determination for Gender-Affirming Surgery

Guidelines for Medical Necessity Determination for Gait Trainers

Guidelines for Medical Necessity Determination for Excision of Excessive Skin and Subcutaneous Tissue