Effective Jan. 1, 2023, the Centers for Medicare & Medicaid Services (CMS) no longer requires Certificates of Medical Necessity and DME Information Forms for selected durable medical equipment (DME). This documentation was originally required to help confirm medical necessity and other coverage criteria. Historically, DME suppliers would receive a signed certificate from the treating physician or a signed form to submit with each claim. However, information from these documents is now available either on the claim or in the medical record.
This policy change is applicable to the following DME only:
- Pneumatic Compression Devices
- Osteogenesis Stimulators
- Transcutaneous Electrical Nerve Stimulators
- Seat Lift Mechanisms
- Section C Continuation Form
- External Infusion Pumps
- Enteral and Parenteral Nutrition
DME Medicare Administrative Contractors were notified of this policy change through a CMS Manual System Transmittal. However, the AASM recommends that members communicate with DME suppliers to ensure that they are aware of the updated policy and have updated workflows to prevent unnecessary administrative burden, as CMS intended. A summary of the change can be found in a May Medicare Learning Network (MLN) communication.
Questions about this policy change can be sent to the AASM health policy team at email@example.com.