Which of the following is NOT a common reason why Medicare may issue a denial for a service treatment?

Medicare typically issues denials based on specific criteria that focus on medical necessity, provider approval, and adherence to established frequency limits for particular services. When considering the reasons for denial, the focus is largely on whether the service meets the clinical standards outlined in Medicare guidelines.

The assertion that "the service is considered to be too expensive" is not a common basis for denial. Medicare does not deny claims simply because the service in question carries a high cost; rather, denials are more contingent on whether the service is appropriate for the patient's condition, whether it was provided by qualified professionals, and if it was administered within the acceptable frequency limits established by Medicare policy.

In contrast, medical necessity—the importance of the service for the patient’s diagnosis or treatment—is a key reason for denial. If a service is deemed not medically necessary, it will be denied because it does not meet the clinical guidelines that justify its provision. Likewise, services that are not performed by approved providers can lead to denial, as eligibility for reimbursement is restricted to services offered by those who meet Medicare's credentialing criteria. Also, exceeding the allowed frequency limit for a service can trigger denial, as these limits are set to prevent over-utilization and ensure that patients receive care that is appropriate and necessary