Get Cms-847 2019-2025

The CMS-847 form is a Certificate of Medical Necessity for osteogenesis stimulators issued by the Centers for Medicare & Medicaid Services. This guide offers comprehensive, step-by-step instructions to assist users in completing the form online.

Follow the steps to successfully complete the CMS-847 form.

1. Click ‘Get Form’ button to access the CMS-847 and open it in the online editor.
2. In Section A, indicate the certification type and date by selecting whether it is an initial, revised, or recertification request. Provide the patient's name, address, telephone number, and Medicare ID.
3. Fill in the supplier's name, address, telephone number, and either the National Supplier Clearinghouse (NSC) number or National Provider Identifier (NPI). Accurately classify the place of service and provide the supply item/service procedure codes.
4. Complete the patient information by entering their date of birth, height, weight, and sex. Specify the details of the physician, including their name, address, and contact information, along with their UPIN or NPI.
5. In Section B, which should not be filled out by the supplier, indicate the estimated length of need in months, and list any relevant diagnosis codes. Respond to the clinical questions specific to the type of osteogenesis stimulator being ordered.
6. Provide the name of the person answering Section B questions if it is someone other than the physician. Completion of this section can be done by a non-physician clinician but must be reviewed by the physician.
7. Proceed to Section C and give a narrative description of the equipment along with the costs, including the supplier's charge and the Medicare fee schedule allowance for each item.
8. Finally, in Section D, the physician must complete the attestation by signing and dating the form, confirming that all information provided is correct and accurate.
9. After reviewing all sections, you may choose to save the changes, download, print, or share the completed CMS-847 form to ensure it is submitted properly.

Start filling out your CMS-847 form online today to ensure a smooth process for medical necessity certification.