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  • Cms-849 2019

Get Cms-849 2019-2025

DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE MEDICAID SERVICES Form Approved OMB No. 0938-0679 CERTIFICATE OF MEDICAL NECESSITY CMS-849 SEAT LIFT MECHANISMS SECTION A DME 07. PHYSICIAN S SIGNATURE DATE // Form CMS-849 09/05 EF 08/2006 INSTRUCTIONS FOR COMPLETING THE CERTIFICATE OF MEDICAL NECESSITY FOR SEAT LIFT MECHANISMS CMS-849 May be completed by the supplier CERTIFICATION TYPE/DATE If this is an initial certification for this patient indicate this by placing date MM/DD/YY needed initially in the space marked INITIAL. If this is a revised certification to be completed when the physician changes the order based on the patient s changing clinical needs indicate the initial date needed in the space marked INITIAL and indicate the recertification date in the space marked REVISED. 03A Certification Type/Date INITIAL // REVISED // RECERTIFICATION// PATIENT NAME ADDRESS TELEPHONE and HIC NUMBER SUPPLIER NAME ADDRESS TELEPHONE and NSC or applicable NPI NUMBER/LEGACY NUMBER ....

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How to fill out the CMS-849 online

The CMS-849 form, formally known as the Certificate of Medical Necessity for seat lift mechanisms, is crucial for healthcare professionals to establish the medical need for certain assistive devices. This guide provides a comprehensive and user-friendly approach to completing the CMS-849 online, ensuring accuracy and clarity throughout the process.

Follow the steps to successfully complete the CMS-849 online.

  1. Click the ‘Get Form’ button to access the CMS-849 and open it in your preferred online editor.
  2. In Section A, choose the appropriate certification type by indicating whether this is an initial, revised, or recertification. Fill in the required patient details including their name, address, telephone number, and Medicare ID.
  3. Complete the supplier information by providing the name, address, and telephone number of your company, along with the NSC or NPI number.
  4. Indicate the place of service where the item will be used, such as the patient’s home or a skilled nursing facility.
  5. List the service procedure codes for the items being ordered in the Supply Item/Service Procedure Code(s) field.
  6. Enter the patient's date of birth, height, weight, and sex to provide essential demographic information.
  7. Provide the physician's name, address, telephone number, and their UPIN or NPI number.
  8. In Section B, include the estimated length of need for the equipment and list all applicable diagnosis codes.
  9. Respond to each clinical question in Section B by marking 'Y' for yes, 'N' for no, or 'D' for does not apply, based on the patient's condition.
  10. If someone other than the physician answered Section B, include their name, title, and employer.
  11. In Section C, describe the equipment and its cost, including the supplier charge and Medicare fee schedule allowance for each item.
  12. In Section D, the physician must attest by signing and dating the form, confirming that the information provided is true and complete.
  13. Finally, save your changes, and download, print, or share the completed CMS-849 as needed.

Complete your documents online with ease to ensure timely processing and compliance.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232