Elimination of Certificates of Medical Necessity & Durable Medical Equipment Information Forms
Date Posted: Tuesday,
August 23, 2022
Provider Types Affected
This MLN Special Edition Article is for providers, suppliers, billers, and vendors who bill Durable Medical Equipment (DME) Medicare Administrative Contractors (MACs) for services and supplies they provide to Medicare patients.
Provider Action Needed
CMS is discontinuing Certificates of Medical Necessity (CMNs) and DME Information Forms (DIFs) effective January 1, 2023.
Make sure your billing and IT staff knows about these changes for CMNs and DIFs:
- For services on or after January 1, 2023: Don't submit CMN or DIF forms or their electronic claim data elements with the claims or CMS will reject your claims and return them to you.
- For services before January 1, 2023: Submit CMN and DIF forms or their electronic claim data elements with the claims if required.
What You Need to Know
Originally, CMS required the CMN and DIF forms to help document medical necessity and other coverage criteria for selected DME. Suppliers got a signed CMN from the treating physician or created and signed a DIF to submit with the claim. Information from these forms is now available either on the claim or in the medical record.
CMS will not accept CMNs and DIFs on claims for dates of service on or after January 1, 2023. If they get a claim with a date of service on or after January 1, 2023, they will reject the claim and return it to you.
For claims with dates of service before January 1, 2023, the process is the same. If the claim requires a CMN or DIF, you must send it with the claim or have it on file from a previous claim.
You don't need to complete these forms for claims with dates of service on or after January 1, 2023:
- CMS-484 - Oxygen
- CMS-846 - Pneumatic Compression Devices
- CMS-847 - Osteogenesis Stimulators
- CMS-848 - Transcutaneous Electrical Nerve Stimulators
- CMS-849 - Seat Lift Mechanisms
- CMS-854 - Section C Continuation Form
- CMS-10125 - External Infusion Pumps
- CMS-10126 - Enteral and Parenteral Nutrition
More Information
CMS issued CR 12734 (https://www.cms.gov/files/document/r11427CP.pdf) to your DME MAC on these changes. Revised portions of the Medicare Claims Processing Manual are part of these instructions.
For more information, find your MAC's (https://www.cms.gov/MAC-info) website.
Source: CMS
