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Click ‘Get Form’ to open it in the editor.
In Section A, fill in the Certification Type/Date by selecting whether this is an Initial, Revised, or Recertification. Enter the patient’s name, address, telephone number, and Medicare ID.
Provide your supplier information including name, address, telephone number, and either NSC or NPI number. Specify the Place of Service and list the Supply Item/Service/Procedure Code(s).
Complete patient details such as Date of Birth, Sex, Height, and Weight. Then enter the Physician's information including name, address, telephone number, and UPIN or NPI.
In Section B, indicate the Estimated Length of Need and fill in Diagnosis Codes. Answer questions 6-12 based on the patient's condition by checking 'Y', 'N', or 'D'.
Section C requires a narrative description of equipment and costs from the supplier. Finally, in Section D, ensure that the physician signs and dates to certify all provided information.
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HCPCS Code for Osteogenesis stimulator, electrical, non-invasive, other than spinal applications E0747.
What is a CMS document?
In the context of content management systems (CMS), documentation is a set of guidelines on how to use a particular CMS. As the word itself hints, documentation documents how to use a CMS.
What is E0747?
Providers sending professional and supplier claims to Medicare on paper must use Form CMS-1500 in a valid version. This form is maintained by the National Uniform Claim Committee (NUCC), an industry organization in which CMS participates.
What is a CMS form used for?
The Form CMS-1500 is the standard paper claim form to bill Medicare Fee-For-Service (FFS) Contractors when a paper claim is allowed. In addition to billing Medicare, the 837P and Form CMS-1500 may be suitable for billing various government and some private insurers.
What are CMS forms?
The Centers for Medicare Medicaid Services (CMS) is a Federal agency within the U.S. Department of Health and Human Services. Many CMS program related forms are available in Portable Document Format (pdf).
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