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Certificates of Medical Necessity and DME Information Forms


Social Security Act Sections 1833(e) and 1834(j)(2); 42 U.S.C. Section 1395m(j)(2)(1998); 42 C.F.R. Section 410.38; CMS Manual System, Pub. 100-04, Medicare Claims Processing Manual, Chapter 20, Section 100.2; CMS Manual System, Pub. 100-08, Medicare Program Integrity Manual, Chapter 5; CMS Ruling 93-1, CMS Change Request 4296 and 5571


A Certificate of Medical Necessity (CMN) is a form required to help document the medical necessity and other coverage criteria for selected durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items. CMNs contain sections A through D. Sections A and C are completed by the supplier and Sections B and D are completed by the physician. A DIF is completed and signed by the supplier. It does not require the cost, a narrative description of equipment or a physician's signature.

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