E0627: Fill out & sign online

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How to use or fill out 849 certificate medical necessity with our platform

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Click ‘Get Form’ to open the 849 certificate medical necessity in the editor.
In Section A, select the certification type and date. Fill in the patient’s name, address, telephone number, and HIC number. Also, provide your supplier information including name, address, and NSC number.
Indicate the place of service and enter the HCPCS code. Complete patient details such as date of birth, height, weight, and sex.
In Section B, estimate the length of need for the equipment. Enter diagnosis codes (ICD-9) relevant to the patient's condition.
Answer questions 1-5 regarding medical necessity by circling Y for Yes, N for No, or D for Does Not Apply.
Section C requires a narrative description of the equipment along with costs. Ensure all items are detailed accurately.
Finally, in Section D, have the physician sign and date to certify that all information is accurate and complete.

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