DME CMN Form CMS - 847 DME CMN Form CMS - 847 2026

1. Click ‘Get Form’ to open the DME CMN Form CMS - 847 in the editor.
2. Begin with Section A, where you will enter the certification type and date. Specify if it’s an initial, revised, or recertification by filling in the appropriate fields.
3. Fill in the patient’s name, address, telephone number, and HICN. Next, provide your supplier information including name, address, and NSC or NPI number.
4. In Section B, which cannot be completed by suppliers, indicate the estimated length of need and diagnosis codes. Answer questions related to medical necessity by checking 'Y', 'N', or 'D' as applicable.
5. Complete Section C with a narrative description of the equipment and associated costs. Ensure all items are detailed accurately.
6. Finally, Section D requires the physician's signature and date to certify that all information is correct and complete.

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