Get Certificate Of Medical Necessity Pneumatic Compression Devices. Certificate Of Medical Necessity

Completing the Certificate of Medical Necessity for pneumatic compression devices is essential for ensuring that users receive the necessary medical equipment. This guide provides clear, step-by-step instructions to help you fill out the form accurately and efficiently.

Follow the steps to fill out the Certificate Of Medical Necessity form.

1. Press the ‘Get Form’ button to access the Certificate of Medical Necessity for pneumatic compression devices and open it in your preferred editor.
2. In Section A, indicate the certification type by checking the appropriate box (Initial, Revised, or Recertification) and fill in the dates as required. Ensure to enter the patient information, including their name, address, telephone number, and Health Insurance Claim Number (HICN). Fill in the supplier's details as well, including name, address, contact number, and National Provider Identifier (NPI) or National Supplier Clearinghouse (NSC) number.
3. Specify the place of service where the device will be used, and include the name and address of the facility if applicable.
4. In Section B, list all relevant HCPCS codes for the items ordered, and fill in the patient's date of birth, sex, height, and weight. Provide the physician's name and contact details, including their NPI or UPIN.
5. Estimate the length of need by indicating the duration in months. If the device is needed for the patient's lifetime, enter '99'. Then, write down the appropriate diagnosis codes in the designated spaces.
6. Answer each of the medical necessity questions, circling 'Y' for Yes and 'N' for No, as applicable. If another person, such as a care professional, is answering these questions, ensure their name, title, and employer are included.
7. In Section C, provide a narrative description of the ordered equipment, including any accessories or options, along with the supplier's charge and the Medicare Fee Schedule allowance for each item.
8. Once all sections are complete, review the form for accuracy. You can save your changes, download, print, or share the form as needed.

Complete the Certificate of Medical Necessity form online to ensure timely access to your pneumatic compression devices.