How does the AMA define medical necessity?

The American Medical Association (AMA) defines medical necessity as services or procedures that are appropriate and necessary to provide a patient with proper healthcare, based on professional judgment. This definition emphasizes the need for a prudent physician—meaning one who is reasonable and exercising good judgment in their practice—to determine what care is essential for a patient's health.

This concept ensures that the focus remains on the patient's medical condition and necessary treatments, rather than external influences such as trends, personal patient preferences, or the stipulations set by insurance companies. By framing medical necessity within the context of a physician's judgment and the clinical needs of the patient, it underscores the importance of professional standards in healthcare rather than subjective factors or external dictates.