Follow the steps to successfully complete the CMS-484 form.

1. Click ‘Get Form’ button to obtain the CMS-484 online and open it in an editor.
2. In Section A, select the appropriate certification type from 'INITIAL', 'REVISED', or 'RECERTIFICATION', and fill in the required dates with the MM/DD/YY format. Enter the patient's name, address, telephone number, and Medicare ID as it appears on their Medicare card.
3. Complete the supplier information by including your company's name, address, telephone number, and either the NSC or NPI number, formatted correctly.
4. Indicate the place of service where the oxygen will be used, and if applicable, provide the name and address of the facility.
5. Provide the physician’s details by entering their name, address, telephone number, and UPIN or NPI number.
6. In Section B, fill in the estimated length of need for the ordered item in months, and input relevant diagnosis codes to justify the medical necessity of oxygen therapy.
7. Answer questions 1-9 using 'Y' for yes, 'N' for no, or 'D' for does not apply, based on the patient's condition and recent test results.
8. If completing Section B but not as the physician, print your name, title, and employer as required.
9. In Section C, provide a narrative description of the ordered items, including any accessories and associated costs, along with the allowable Medicare fee schedule amounts.
10. Finalize the form by obtaining the physician's signature in Section D, certifying the accuracy of the provided information and attesting to the medical necessity.

Complete the CMS-484 online now for efficient processing and compliance.