Medicare form cms 849 2026

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The document is a Certificate of Medical Necessity (CMS-849) for seat lift mechanisms, issued by the Department of Health and Human Services. It outlines the certification process for medical equipment needed by patients, including sections for patient and supplier information, physician details, diagnosis codes, and a series of questions to determine medical necessity. The form requires physician attestation to confirm that the equipment is necessary for the patient's health condition.

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Click ‘Get Form’ to open the CMS-849 in the editor.
In Section A, fill in the Certification Type/Date by selecting whether it is an Initial, Revised, or Recertification. Enter the patient’s name, address, telephone number, and HIC number.
Provide your supplier information including name, address, telephone number, and either NSC or NPI number. Specify the Place of Service and Facility Name if applicable.
In Section B, enter the HCPCS codes for items ordered. Fill in patient details such as date of birth, height, weight, and sex. Answer questions regarding medical necessity by circling Y for Yes, N for No, or D for Does Not Apply.
Complete Section C with a narrative description of equipment and costs. Include supplier charges and Medicare fee schedule allowances.
Finally, in Section D, ensure the physician signs and dates the form to certify that all information is accurate.

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