US · guidance
CMS Pub. 100-08, ch. 5, § 5.18.3
Instructions for Processing ADMC Requests
Once a request is received, the DME MAC shall determine if there is sufficient medical
documentation that supports whether the item is reasonable and necessary. In addition, a
review of the beneficiary’s claims’ history should be conducted in order to determine
whether any other reason exists to cause the claim to be denied, e.g., whether the same or
similar equipment has already been provided.
Upon receipt of a request, the DME MAC shall render an advance determination of
Medicare coverage within 30 calendar days. DME MACs shall provide the requestor with
their decision, be it affirmative or negative, in writing.
If requests are received for the wrong item(s), the request will be rejected. Rejected
requests should not be counted as workload.
Requests for appropriate items received without documentation to support coverage will
be denied as not meeting the medical necessity requirements Medicare has established for
the item.
History
(Rev. 10190; Issued: 06-19-2020; Effective: 01-01-2020; Implementation: 07-01- 2020)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
29f007c499e0b2763fe0f4041cba8aa48cee0aa688fbfd5c63c6c3869c1ba0f3
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.