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 doctor's agent. Your supplier will coordinate with your doctor to see that all the necessary information is submitted to Medicare. A change in prescription and/or a change in the beneficiary’s condition will require that an updated certificate be completed and submitted.

Note: The CMN must be completed and returned to the supplier prior to the beneficiary receiving the item. A completed CMN does not guarantee that Medicare will cover the item as medical necessity is determined by the prescriber’s responses to the questions on the CMN.