CMS Pub. 100-04, ch. 20, § 50

NOTE: CMS seeks to reduce burden and modernize processes to ensure a reduction in

improper payments and an increase in customer satisfaction. The Certificate of Medical

Necessity (CMN) form and DME Information Form (DIF) were originally required to

help document the medical necessity and other coverage criteria for selected Durable

Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items. In the past, a

supplier received a signed CMN from the treating physician or created and signed a DIF

to submit with the claim. Due to improvements in claims processing and medical records

management, the information found on CMNs or DIFs is available either on the claim or

in the medical record and is redundant. Therefore, to reduce burden and increase

customer satisfaction, providers and suppliers no longer need to submit these forms for

services rendered after January 1, 2023.

• For claims with dates of service on or after January 1, 2023 – providers and

suppliers no longer need to submit CMNs or DIFs with claims. Due to electronic

filing requirements, claims received with these forms attached will be rejected and

returned to the provider or supplier.

• F or claims with dates of service prior to January 1, 2023 – processes will not

change and if the CMN or DIF is required, it will still need to be submitted with

the claim, or be on file with a previous claim.

This statement applies throughout the Program Integrity Manual wherever CMNs and

DIFs are mentioned.

B3-5102.2.B

Replacement of equipment which the beneficiary owns or is purchasing or is a capped

rental item is covered in cases of loss, or irreparable damage or wear, and when required

because of a change in the patient's condition subject to the following provisions.

Expenses for replacement required because of loss or irreparable damage may be

reimbursed without a physician's order when, in the DME MAC’s judgment, the

equipment as originally ordered, considering the age of the order, still fills the patient's

medical needs. However, claims involving replacement equipment necessitated because

of wear or a change in the patient's condition must be supported by a current physician's

order. (See the Medicare Benefit Policy Manual, Chapter 16, for payment for equipment

replaced under a warranty.)

DME MACs investigate and deny cases suggesting malicious damage, culpable neglect

or wrongful disposition of equipment as discussed in the Benefit Policy Manual, Chapter

15, where it is determined that it is unreasonable to make program payment under the

circumstances. They refer such cases to the program integrity specialist in the RO.

DME MACs do not pay for replacement of rented equipment except capped rental items.

(See §50.1) However, they pay for replacement of purchased equipment in the following

classes: inexpensive or routinely purchased, customized items, capped rental (where the

beneficiary has elected to purchase the item), and other prosthetic and orthotic devices.

They do not pay for purchase or replacement of items that require frequent and

substantial servicing or oxygen equipment.