Getty Images
CMS Suspends Certificates of Medical Necessity, DME Forms for 2023
According to stakeholder feedback, submitting Certificates of Medical Necessity and Durable Medical Equipment Information Forms was challenging and burdensome for small and rural providers.
CMS has announced that it will no longer require healthcare stakeholders to submit Certificates of Medical Necessity (CMNs) or Durable Medical Equipment (DME) Information Forms (DIFs) for service claims on or after January 1, 2023.
The change is part of the Biden-Harris Administration’s goal of improving access to quality, affordable healthcare by allowing quicker access to necessary medical supplies for Medicare beneficiaries.
Discontinuing the CMNs and DIFs will also relieve administrative burden for healthcare stakeholders, including providers, suppliers, billers, and vendors who bill DME Medicare Administrative Contractors (MACs) for services and supplies for Medicare beneficiaries.
For example, frontline clinicians will be able to focus on providing direct care to patients, while suppliers will experience a streamlined coverage process.
Before this announcement, CMS required stakeholders to submit CMNs and DIFs to help document medical necessity and other coverage criteria for DME. Suppliers would get a signed CMN from the physician or create and sign a DIF to submit with the claim.
CMS received feedback from stakeholders that CMNs and DIFs were burdensome and repeated information already available on claims or in medical records. In addition, submitting these forms is often challenging for small and rural providers without administrative staff and technical support.
Following this feedback, CMS determined that the forms were no longer necessary. In the future, the medical necessity information and coverage criteria for a service can be found on the claim or in the medical record
Suppliers must continue to submit CMNs and DIFs for claims with service dates before January 1, 2023, if required. The process for these claims has not changed and suppliers must send the forms with the claim or have them on file from a previous claim.
CMS said that starting on January 1, 2023, claims that include CMN or DIF information will be rejected and returned to the supplier.
Specifically, the following CMNs and DIFs will no longer be required for services in 2023:
- 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
- CMS-10125 – External Infusion Pumps
- CMS-10126 – Enteral and Parenteral Nutrition
