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

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The document is a Certificate of Medical Necessity (CMN) form (CMS-847) for osteogenesis stimulators, issued by the Centers for Medicare & Medicaid Services. It outlines the necessary information required to certify the medical necessity of these devices for patients, including patient and supplier details, diagnosis codes, and specific clinical questions that must be answered by the physician. The form also includes sections for physician attestation and instructions for completion.

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Click ‘Get Form’ to open the DME CMN Form CMS - 847 in the editor.
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.
Fill in the patient’s name, address, telephone number, and HICN. Next, provide your supplier information including name, address, and NSC or NPI number.
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.
Complete Section C with a narrative description of the equipment and associated costs. Ensure all items are detailed accurately.
Finally, Section D requires the physician's signature and date to certify that all information is correct and complete.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (263 Votes)
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2005	4.3 Satisfied (70 Votes)

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What is a Medicare CMN form?

What is a certificate of medical necessity (CMN)? A Certificate of Medical Necessity (CMN) is a form required by Medicare authorizing the use of certain durable medical items and equipment prescribed by a physician. This form is to be completed by your doctor or the doctors agent.

What are examples of CMN usage?

A certificate of Medical Necessity (CMN) is valid for 12 months from the date of issue.

What is the purpose of the CMN?

There are different types of CMN for different requirements, e.g., pumps, home health and private duty nursing services, etc. A CMN typically requires several dates to be specified, such as: The initial date of the CMN.

Does Medicare pay for bone growth stimulators?

If granted, the authorization covers a maximum period of one (1) year, subject to renewal. Complete all applicable items (see DOL reimbursement standards under item 11 on the CMN form). This form must be signed and dated by the treating physician.