US · guidance
CMS Pub. 100-04, ch. 30, § 150.5.2.8
Presumption for Medical Necessity
In the case of an optional request for an advance determination of coverage of a
customized item of medical equipment and supplies under §1834(a)(15)(C)(iii) of the Act
by the patient to whom the item is to be furnished or the supplier, in determining whether
the supplier knew, or could reasonably have been expected to know, that Medicare would
deny payment in advance under §1834(a)(15) of the Act, presume that the supplier knew
that Medicare would not pay in all cases in which you denied payment in advance on the
basis that the item is not reasonable and necessary under §1862(a)(1) of the Act or that
the item is not covered. This is a nonrebuttable presumption.
History
(Rev. 1, 10-01-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
017423dbbfa38be9285e81ca6d565257f5a4cb6e4316661ed6427feae8ed98bb
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