Summary


Medicaid coverage determinations are made when all criteria of medical necessity are met. As such, Florida Medicaid must determine if a diagnostic test, therapeutic procedure, or medical device or technology is experimental or investigational. This rule provides the guidelines that Florida Medicaid will use when determining the circumstances under which a diagnostic test, therapeutic procedure, or medical device or technology is consistent with generally accepted professional medical standards. This rule also includes the types of information to be considered in the decision-making process and names the person(s) qualified to make the final determination.