Certificate of Medical Necessity (CMN)
A CMN is a document signed by the prescribing provider containing clinical information that supports the need for each item, services, or supplies requested for a beneficiary.
A physician’s order or prescription itself can take the place of the CMN as long as it includes the necessary elements and signature. It is very important that the CMN or physician order be complete and current for the services/supplies/equipment to be covered. A copy of the CMN or order must be submitted with the claim. Be sure to keep the CMN on file for at least one year.
A CMN must include:
- Type of equipment
- Diagnosis or reason
- Length of need*
- Beginning date
- Physician signature (nurse practitioner and physician assistant signatures are accepted)
*Length of need for Capped DME items should cover a 15 month period.
Any time there is a change in the prescription, the physician must provide an updated or new prescription or CMN for the DME to be submitted for claims.
Some DME, Prosthetics, Orthotics and medical Supplies (DMEPOS) are a limited benefit.
Breast pumps and supplies services are determined by patient/newborn need; physician order/Certificate of Medical Necessity (CMN) requirements apply.