Not Medically Necessary and Not Investigational
Evaluation and clinical recommendations are assessed according to the scientific quality of the supporting evidence and rationale (such as national medical associations, independent panels or technology assessment organizations).
A service is considered not medically necessary and not investigational if it meets any of the following criteria:
- There are no studies of the service described in recently published peer-reviewed medical literature
- There are no active or ongoing credible evaluations being undertaken of the service, which has previously been considered not medically necessary
- There is conclusive evidence in published peer-reviewed medical literature that the service is not effective
- There are no peer-reviewed scientific studies published or accepted for publication by nationally recognized medical journals that demonstrate the safety or efficacy of the use of the service
- It is contraindicated