---
title: O.C.G.A. § 33-20A-40. Determining medical necessity or whether a treatment is experimental.
collection: code
id: 33-20A-40
cite_as: O.C.G.A. § 33-20A-40 (2025)
canonical_url: https://georgiacommons.org/code/33-20A-40
md_url: https://georgiacommons.org/code/33-20A-40.md
text_url: https://georgiacommons.org/code/33-20A-40/text
source_url: https://www.legis.ga.gov/api/document/docs/default-source/joint-features-document-library/t33-ch1-22-(v24)-2020-pdf.pdf?sfvrsn=a873240d_0#page=834
date: 2025
status: active
corpus_version: 2025-supplement-89aa39ab3c68
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publisher: Georgia Commons, an independent project of Georgia Civic Data. Not the State of Georgia. Not legal advice.
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version: the only printed version
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current_through: Including Acts of the 2025 Regular Session of the General Assembly
heading_path: INSURANCE / MANAGED HEALTH CARE PLANS / PATIENT’S RIGHT TO INDEPENDENT REVIEW
---

# O.C.G.A. § 33-20A-40. Determining medical necessity or whether a treatment is experimental.

(a) For the purposes of this article, in making a determination as to whether a treatment is medically necessary and appropriate, the expert reviewer shall use the definition provided in paragraph (7) of Code Section 33-20A-31.

(b) For the purposes of this article, in making a determination as to whether a treatment is experimental, the expert reviewer shall determine:

(1) Whether such treatment has been approved by the federal Food and Drug Administration; or

(2) Whether medical and scientific evidence demonstrates that the expected benefits of the proposed treatment would be greater than the benefits of any available standard treatment and that the adverse risks of the proposed treatment will not be substantially increased over those of standard treatments.

For either determination, the expert reviewer shall apply prudent professional practices and shall assure that at least two documents of medical and scientific evidence support the decision.

## History

Code 1981, § 33-20A-40, enacted by Ga. L. 1999, p. 350, § 3; Ga. L. 2005, p. 1438, § 2/SB 140.