US · guidance
CMS Pub. 100-08, ch. 5, § 5.19
DME MAC Tracking
The DME MACs shall develop the capability to track ADMC requests in order to assure
that decisions are rendered in a timely and appropriate fashion. DME MACs shall also
develop the capability to ensure that: 1) items for which an affirmative ADMC decision
was made are not denied as not meeting the medical necessary requirements of the
policy, and 2) claims for item that received a negative ADMC decision are denied as not
covered, unless additional medical documentation submitted with the claims supports
coverage.
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
a394766ee58e39baffce19f57dd725004d44bbb9291adea3c3392f33635906c6
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