Get Certificate Of Medical Necessity

Completing the Certificate Of Medical Necessity (CMS-484) online can make the process of obtaining necessary medical equipment more efficient. This guide provides you with a step-by-step approach to filling out the form accurately and comprehensively.

Follow the steps to successfully complete the Certificate Of Medical Necessity.

1. Press the ‘Get Form’ button to obtain the Certificate Of Medical Necessity form and open it for editing.
2. In Section A, select the appropriate certification type by marking ‘INITIAL’, ‘REVISED’, or ‘RECERTIFICATION’, and enter the corresponding dates.
3. Fill in the patient's information including their name, address, telephone number, and Health Insurance Claim number (HICN) as it appears on their Medicare card.
4. Provide the supplier information by entering your company's name, address, telephone number, and either the National Supplier Clearinghouse (NSC) number or National Provider Identifier (NPI).
5. Indicate the place of service where the equipment is being used, and if applicable, the name and address of the facility.
6. List the HCPCS codes for the items ordered, as well as the patient's date of birth, height, weight, and sex.
7. In Section B, answer the questions regarding the patient's medical condition and the necessity for the prescribed equipment by circling ‘Y’, ‘N’, or ‘D’.
8. Complete Section C with a narrative description of the equipment, detailing the quantity and costs involved.
9. Have the physician attest to the information in Section D by signing and dating the certificate.
10. Once all sections are completed, save your changes, and download, print, or share the form as needed.

Start filling out your Certificate Of Medical Necessity online today to ensure seamless processing.