Services which have been determined by BlueCross BlueShield of Tennessee to be of value in the care of a specific Member. To be Medically Appropriate a service must:
Be Medically Necessary.
Be used to diagnose or treat a member's condition caused by disease, injury or congenital malformation.
Be consistent with current standards of good medical practice for the Member's medical condition.
Be provided in the most appropriate site and at the most appropriate level of service of the member's medical condition.
On an ongoing basis have a reasonable probability of:
Correcting a significant congenital malformation or disfigurement caused by disease or injury.
Preventing significant malformation or disease.
Substantially improving a life sustaining bodily function impaired by disease or injury.
Not be provided solely to improve a Member's condition beyond normal variation in individual development and aging including:
Comfort measures in the absence of disease or injury.
Improving physical appearance that is with in normal individual variation.
Not be for the sole convenience of the Provider Member or Member's family.
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