US · guidance
CMS Pub. 100-02, ch. 7, § 20.1.1
Background
In enacting the Medicare program, Congress recognized that the physician or allowed
practitioner would play an important role in determining utilization of services. The law
requires that payment can be made only if a physician or allowed practitioner certifies the
need for services and establishes a plan of care. The Secretary is responsible for ensuring
that Medicare covers the claimed services, including determining whether they are
"reasonable and necessary."
History
(Rev. 10438, Issued: 11-06-20, Effective: 03-01-20, Implementation: 01- 11-21)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
6e1035b32c70efc4b2f52fc82fd6cb11ddac1bd00a6062aa4076530e169b4f64
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