42 CFR § 456.702 - Definitions.

---
identifier: "/us/cfr/t42/s456.702"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 456.702 - Definitions."
title_number: 42
title_name: "Public Health"
section_number: "456.702"
section_name: "Definitions."
chapter_name: "CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES"
subchapter_number: "C"
subchapter_name: "MEDICAL ASSISTANCE PROGRAMS"
part_number: "456"
part_name: "UTILIZATION CONTROL"
positive_law: false
currency: "2026-03-24"
last_updated: "2026-03-24"
format_version: "1.1.0"
generator: "[email protected]"
authority: "42 U.S.C. 1302."
regulatory_source: "43 FR 45266, Sept. 29, 1978, unless otherwise noted."
cfr_part: "456"
---


# 456.702 Definitions.

For purposes of this subpart—

*Abuse* is defined as in § 455.2 of this chapter.

*Adverse medical result* means a clinically significant undesirable effect, experienced by a patient, due to a course of drug therapy.

*Appropriate and medically necessary* means drug prescribing and dispensing that is in conformity with the predetermined standards established in accordance with § 456.703.

*Criteria* is defined as in § 466.1 of this chapter.

*Fraud* is defined as in § 455.2 of this chapter.

*Gross overuse* means repetitive overutilization without therapeutic benefit.

*Inappropriate and medically unnecessary* means drug prescribing and dispensing not in conformity with the definition of *appropriate and medically necessary.*

*Overutilization* means use of a drug in a quantity, strength, or duration that is greater than necessary to achieve a desired therapeutic goal or that puts the beneficiary at risk of a clinically significant undesirable effect, or both.

*Predetermined standards* means criteria and standards that have been established in accordance with the requirements of § 456.703.

*Standards* is defined as in § 466.1 of this chapter.

*Underutilization* means use of a drug by a beneficiary in insufficient quantity, strength, or duration to achieve a desired therapeutic goal or that puts the beneficiary at risk of a clinically significant undesired effect, or both.

[57 FR 49408, Nov. 2, 1992, as amended at 59 FR 48824, Sept. 23, 1994]