According to Medicare, medically necessary services are those needed to diagnose or treat your medical condition while meeting accepted standards of medical practice. This definition forms the foundation for all Medicare coverage decisions.

You can determine if Medicare covers a specific service in two ways. First, discuss your needs with your doctor or healthcare provider and ask about Medicare coverage. Your doctor may have you sign a notice if there’s uncertainty about coverage, indicating you might pay out-of-pocket if Medicare denies the claim. Second, check the Medicare website to look up specific tests, items, or services to verify coverage.

Medicare bases coverage decisions on federal and state laws plus national coverage determinations that establish nationwide standards. Common examples of medically necessary services include diagnostic tests ordered by your physician, prescription medications for treating diagnosed conditions, and durable medical equipment like wheelchairs when mobility is impaired. Medicare typically doesn’t cover services it considers experimental, cosmetic procedures, or items primarily for convenience rather than medical treatment.