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 Cranial Orthoses

MassHealth. (MassHealth, 2023-03)
Guidelines for Medical Necessity Determination for Mastectomy for Gynecomastia

MassHealth. (MassHealth, 2023-02-06)
Guidelines for Medical Necessity Determination for Rhinoplasty and Septoplasty

MassHealth. (MassHealth, 2022-12-12)
Guidelines for Medical Necessity Determination for Breast Reconstruction and Breast Implant Removal

MassHealth. (MassHealth, 2022-11)
Guidelines for Medical Necessity Determination for Botulinum Toxin in the Treatment of Hyperhidrosis

MassHealth. (MassHealth, 2022-10)
Guidelines for Medical Necessity Determination for the Treatment of Erectile Dysfunction

MassHealth. (MassHealth, 2022-10-17)
Guidelines for Medical Necessity Determination for Orthognathic Surgery

MassHealth. (MassHealth, 2022-10)
Guidelines for Medical Necessity Determination for Day Habilitation

MassHealth. (MassHealth, 2022-10)
Guidelines for Medical Necessity Determination for High Frequency Chest Wall Oscillation Air-Pulse Generator System (Vest)

MassHealth. (MassHealth, 2022-07)
Guidelines for Medical Necessity Determination for Diabetes Management Devices: Continuous Glucose Monitoring Systems and Insulin Pumps

MassHealth. (MassHealth, 2022-07)
Guidelines for Medical Necessity Determination for Cochlear Implantation

MassHealth. (MassHealth, 2022-07-07)
Guidelines for Medical Necessity Determination for Enteral Nutrition and Special Medical Formulas

MassHealth. (MassHealth, 2022-06)
Guidelines for Medical Necessity Determination for CardioMEMS

MassHealth. (MassHealth, 2022-05)
Guidelines for Medical Necessity Determination for Hair Removal

MassHealth. (MassHealth, 2021-09-01)
Guidelines for Medical Necessity Determination for Gender-Affirming Surgery

MassHealth. (MassHealth, 2021-09-01)
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 Determinations

Browse by

Recent Submissions

Guidelines for Medical Necessity Determination for Cranial Orthoses ﻿

Guidelines for Medical Necessity Determination for Mastectomy for Gynecomastia ﻿

Guidelines for Medical Necessity Determination for Rhinoplasty and Septoplasty ﻿

Guidelines for Medical Necessity Determination for Breast Reconstruction and Breast Implant Removal ﻿

Guidelines for Medical Necessity Determination for Botulinum Toxin in the Treatment of Hyperhidrosis ﻿

Guidelines for Medical Necessity Determination for the Treatment of Erectile Dysfunction ﻿

Guidelines for Medical Necessity Determination for Orthognathic Surgery ﻿

Guidelines for Medical Necessity Determination for Day Habilitation ﻿

Guidelines for Medical Necessity Determination for High Frequency Chest Wall Oscillation Air-Pulse Generator System (Vest) ﻿

Guidelines for Medical Necessity Determination for Diabetes Management Devices: Continuous Glucose Monitoring Systems and Insulin Pumps ﻿

Guidelines for Medical Necessity Determination for Cochlear Implantation ﻿

Guidelines for Medical Necessity Determination for Enteral Nutrition and Special Medical Formulas ﻿

Guidelines for Medical Necessity Determination for CardioMEMS ﻿

Guidelines for Medical Necessity Determination for Hair Removal ﻿

Guidelines for Medical Necessity Determination for Gender-Affirming Surgery ﻿

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 Cranial Orthoses

Guidelines for Medical Necessity Determination for Mastectomy for Gynecomastia

Guidelines for Medical Necessity Determination for Rhinoplasty and Septoplasty

Guidelines for Medical Necessity Determination for Breast Reconstruction and Breast Implant Removal

Guidelines for Medical Necessity Determination for Botulinum Toxin in the Treatment of Hyperhidrosis

Guidelines for Medical Necessity Determination for the Treatment of Erectile Dysfunction

Guidelines for Medical Necessity Determination for Orthognathic Surgery

Guidelines for Medical Necessity Determination for Day Habilitation

Guidelines for Medical Necessity Determination for High Frequency Chest Wall Oscillation Air-Pulse Generator System (Vest)

Guidelines for Medical Necessity Determination for Diabetes Management Devices: Continuous Glucose Monitoring Systems and Insulin Pumps

Guidelines for Medical Necessity Determination for Cochlear Implantation

Guidelines for Medical Necessity Determination for Enteral Nutrition and Special Medical Formulas

Guidelines for Medical Necessity Determination for CardioMEMS

Guidelines for Medical Necessity Determination for Hair Removal

Guidelines for Medical Necessity Determination for Gender-Affirming Surgery

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