Importance of Medical Necessity [2020]

Importance of Medical necessity is one of the Key factor in Medical Billing and Coding to get faster payment for a claim in the Medical Billing Process.  Nowadays, all insurance companies pay based on the Medical Necessity, so Medical Coders and Billers need to verify the diagnosis codes are updated correctly for procedures before submitting the claim.

In the post, we are going to see the Importance of Medical Necessity in Medical Billing and Coding and why it needed.

What is Medical Necessity?

The treatments and the reasons for performing them are the Important factors of medical necessity, and the medical coder and biller must clarify them correctly in a document by choosing the right codes. Just put the diagnosis code without verifying will let the claim to denial. The insurance company will pay only those procedures that are meeting medically necessary.

Why Medical Necessity Needed in Medical Billing and Coding?

If you want the Insurance Company to approve the claim for the payment, then it Important to make sure that the reason behind every procedure a medical professional performs. Let's, see a good example [Ex:  if a Chest pain stated in the medical record, the payer would only pay for the Chest pain-related diagnosis codes, not for shoulder pain, even though both occurred in the same incident. The treatment needs to match in with the medical record]. I hope you understand the process what how to select the correct code for the procedure done by Physician.

What is the Role of Medical Biller and Coders in the Medical Necessity process?

Medical Billers and Coders must understand the role so that the practice  will achieve their Target. The duty of the Medical Billing and Coders is not to make up a payable code. Medical Billers and Coders' work duty is to verify whether the code in the report follows the treatment that is being billed. If you think the diagnosis code does not represent the right procedure, please ask for clarity.


Don't ever think about what the doctor meant to suggest. Take the time to follow up on any concerns you may have regarding the coding question. Using it would save your time and unwanted trouble later.

If having any questions, please comment below and comment on your understanding of Medical Necessity.


  1. Positive site, where did u come up with the information on this posting?I have read a few of the articles on your website now, and I really like your style. Thanks a million and please keep up the effective work. Medical Billing Specialist

  2. I admit, I have not been on this web page in a long time... however it was another joy to see It is such an important topic and ignored by so many, even professionals. I thank you to help making people more aware of possible issues. sviluppo sito ecommerce

  3. The medical billing career field isn't for everyone; it requires patience, flexibility, and analytical skills to use proper medical codes and bill insurance companies correctly. And it's a career field for people who want to work in the medical field, but would prefer to work in the administrative side, rather than in the clinical side with patients. If the medical billing career fields sounds interesting to you, then check out the top 5 reasons to work in medical billing and coding. Medical Billing