Get Cms-846 2017-2025

The CMS-846 is a Certificate of Medical Necessity for pneumatic compression devices. This guide will provide you with step-by-step instructions to complete the form accurately and efficiently.

Follow the steps to fill out the CMS-846 form online.

1. Click the ‘Get Form’ button to access the form and open it in your preferred editor.
2. In Section A, indicate the certification type and date by checking either 'INITIAL,' 'REVISED,' or 'RECERTIFICATION.' Enter the patient’s name, address, telephone number, and Medicare ID as listed on their card.
3. Provide the supplier's name, address, and telephone number along with your National Supplier Clearinghouse (NSC) or National Provider Identifier (NPI) number.
4. Specify the place of service using the appropriate code, and list the supply item or service procedure code(s). Additionally, fill in the patient’s date of birth, height, weight, and sex.
5. Fill in the physician's name, address, and their Unique Physician Identification Number (UPIN) or NPI number.
6. In Section B, input the estimated length of need in months and the necessary diagnosis codes. Answer the questions about the patient's medical condition by checking 'Y' for Yes, 'N' for No, or 'D' for does not apply.
7. If someone other than the physician answered Section B, they must print their name, title, and employer in the designated fields.
8. Section C requires a narrative description of the equipment, including the supplier’s charge and the Medicare Fee Schedule Allowance for each item.
9. In Section D, the physician must review the completed sections and sign and date the form, confirming the information provided is accurate.
10. Once all sections are completed, you can save your changes, download, print, or share the form as needed.

Complete your CMS-846 form online today for a streamlined filing experience.