Certificate of medical necessity

From WikiMD's Wellness Encyclopedia

Certificate of Medical Necessity (CMN) is a form required by insurance companies and Medicare to attest that a medical service or piece of equipment is medically necessary. The CMN is typically completed by a healthcare provider and includes information about the patient's condition and the treatment or equipment required.

Overview[edit | edit source]

A Certificate of Medical Necessity is a document that provides evidence of a patient's medical need for certain services or equipment. It is often used in the context of durable medical equipment (DME), such as wheelchairs, oxygen equipment, or hospital beds. The CMN must be completed by a healthcare provider, such as a physician, nurse practitioner, or physician assistant, who is familiar with the patient's medical condition and needs.

Purpose[edit | edit source]

The primary purpose of a CMN is to provide documentation to insurance companies or Medicare that a particular service or piece of equipment is medically necessary for a patient. This is important because many insurance policies and Medicare only cover services or equipment that are deemed medically necessary. Without a CMN, a patient may be denied coverage for these services or equipment.

Components[edit | edit source]

A CMN typically includes the following components:

  • Patient's name and insurance information
  • Description of the patient's medical condition
  • Explanation of why the service or equipment is medically necessary
  • Signature of the healthcare provider

Process[edit | edit source]

The process for obtaining a CMN typically involves the following steps:

  1. The patient's healthcare provider determines that a particular service or equipment is medically necessary.
  2. The healthcare provider completes the CMN, including all necessary information about the patient's condition and the need for the service or equipment.
  3. The completed CMN is submitted to the patient's insurance company or Medicare for review.
  4. The insurance company or Medicare reviews the CMN and makes a decision about whether to cover the service or equipment.

See also[edit | edit source]


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Contributors: Prab R. Tumpati, MD