US · guidance
CMS Pub. 100-08, ch. 5, § 5.18.5
Negative ADMC Decisions
A negative ADMC decision communicates to the supplier and the beneficiary that, based
on the information submitted with the request, the beneficiary does not meet the medical
necessity requirements Medicare has established for the item. The negative ADMC
decision should indicate why the request was denied.
A beneficiary or a supplier can resubmit an ADMC request if additional medical
documentation is obtained that could affect the prior negative ADMC decision. However,
requests may only be submitted once during a 6-month period.
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
8541085bae955d96a9283b070da301b35df273b201196c33a2715dbae8698dbd
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