For certain items or services billed to a DMERC or DMERC PSC, the supplier must receive a signed CMN from the treating physician.

A supplier must have a faxed or copied, original signed order or CMN in their records before they can submit a claim for payment to Medicare.

CMNs communicate required medical necessity information and must be maintained by the supplier and available to the DMERCs and DMERC PSCs on request.

The DMERCs and DMERCs PSCs retain the authority to request additional documentation to support the claim

Downloads
CMS 484 [PDF, 62KB] CMS 841[PDF, 47KB] CMS 842 [PDF, 41KB] CMS 843 [PDF, 9KB] CMS 844 [PDF, 9K] CMS 846 [PDF, 51KB] CMS 847 [PDF, 57KB] CMS 848 [PDF, 57KB] CMS 850 [PDF, 8KB] CMS 851 [PDF, 64KB] CMS 852 [PDF, 60KB] CMS 853 [PDF, 64KB] CMS 854 [PDF, 23KB]
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Page Last Modified: 12/14/2005 12:00:00 AM
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