Centers for Medicare & Medicaid Services (CMS) is discontinuing Certificates of Medical Necessity (CMNs) and DME Information Forms (DIFs) effective January 1, 2023. You can update your billing team on this crucial announcement and prior January 1, 2023 can submit CMN and DIF forms or their electronic claim data elements with the claims (if required). After the effective date if you submit CMN or DIF forms or their electronic claim data elements with the claims then your claim will get rejected.
Originally, CMS required the CMN and DIF forms to help document medical necessity and other coverage criteria for selected DME. Suppliers got a signed CMN from the treating physician or created and signed a DIF to submit with the claim. Information from these forms is now available either on the claim or in the medical record. As mentioned earlier, CMS will not accept CMNs and DIFs on claims for dates of service on or after January 1, 2023.
The Certificates of Medical Necessity (CMNs) forms that shall be eliminated are as follows:
- CMS-484 – Oxygen
- CMS-846 – Pneumatic Compression Devices
- CMS-847 – Osteogenesis Stimulators
- CMS-848 – Transcutaneous Electrical Nerve Stimulators
- CMS-849 – Seat Lift Mechanisms
- CMS-854 – Section C Continuation Form
The Durable Medical Equipment Forms (DIFs) forms that shall be eliminated are as follows:
- CMS-10125 – External Infusion Pumps
- CMS-10126 – Enteral and Parenteral Nutrition
Certificate of Medical Necessity (CMN) and DME Information Form (DIF)
A Certificate of Medical Necessity (CMN) or a DME Information Form (DIF) is a form required to help document the medical necessity and other coverage criteria for selected durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items. CMNs contain sections A through D. Sections A and C are completed by the supplier and Sections B and D are completed by the physician. A DIF is completed and signed by the supplier. It does not require the cost, a narrative description of equipment or a physician’s signature.
For certain items or services billed to a DME MAC, the supplier must receive a signed CMN from the treating physician or a signed DIF from the supplier. A supplier must have a signed order and an electronic CMN or DIF in their records before they can submit a claim for payment to Medicare. CMNs or DIFs have a DME MAC form number (e.g., 01, 02, 03) and a revision number (e.g., .01, .02). Some forms also have an alpha suffix (e.g., A, B, C).
All CMNs and DIFs have a CMS form number in addition to the DME MAC form number. The CMS form number is in the bottom left corner of the form. CMNs and DIFs are referred to by their CMS form numbers. DME MAC form numbers identify the CMN on electronic claims submitted to the DME MAC. A completed CMN or DIF must be maintained by the supplier and made available to the DME MAC on request. When hardcopy CMNs or DIFs are submitted to the DME MAC, the supplier must include a copy of only the front side. When CMNs are submitted electronically, information from sections A and B are required.
Medisys Data Solutions is a leading medical billing company providing complete assistance in medical billing and coding for your practice. We shared billing update on DMEPOS for your reference only, you can also refer MLN document for more information. If you need any assistance for Durable Medical Equipment (DME) Billing services, contact us at firstname.lastname@example.org/ 302-261-9187