Certification of Medical Necessity Forms
The Center for Medicare and Medicaid Services (CMS) [formerly known as the Health Care Financing Authority (HCFA)] provides forms which may be used as prescriptions or DMNs by the provider in obtaining prior authorization, or to keep on file for apnea/bradycardia monitors, alternating pressure pad/pump, blood glucose monitors, continuous positive airway pressure device, intermittent assist device, electric breast pumps, enteral nutrition, hospital beds, insulin infusion pumps, nebulizers, oxygen, patient lifts, suction pump, volume ventilators, and wheelchairs (custom, standard, power and scooter). The information requested on these forms assists the reviewer in determining medical necessity for the equipment requested. Although the provider is not required to use these forms, the information that the forms contain is vital in the expeditious review and processing of requests for prior authorization. If the provider has forms that contain this information, they may be used instead of those provided on the CMS web site at cms.hhs.gov/forms