Durable Medical Equipment Medicare Administrative Contractors (MAC) Regional Carrier, Certificate of Medical Necessity and Supporting Documentation

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0679 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-847 Durable Medical Equipment Medicare Administrative Contractors (MAC) Regional Carrier, Certificate of Medical Necessity and Supporting Documentation Form and Instruction
CMS-847 CMS-847 -- OSTEOGENESIS STIMULATORS CMS847.pdf Form and Instruction
CMS-846 CMS-846 -- PNEUMATIC COMPRESSION DEVICES CMS846.pdf Form and Instruction
CMS-848 CMS-848 -- TRANSCUTANEOUS ELECTRICAL NERVE STIMULATOR (T CMS848.pdf Form and Instruction
CMS-849 CMS-849 -- SEAT LIFT MECHANISMS CMS849.pdf Form and Instruction
CMS-854 CMS-854 -- CONTINUATION FORM CMS854.pdf Form and Instruction
CMS-10125 CMS-10125 -- EXTERNAL INFUSION PUMPS CMS10125.pdf Form and Instruction
CMS-10126 CMS-10126 -- ENTERAL AND PARENTERAL NUTRITION CMS10126.pdf Form and Instruction
CMS-10269 POSITIVE AIRWAY PRESSURE (PAP) DEVICES FOR OBSTRUCTIVE S CMS-10269.CPAP.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Durable Medical Equipment Medicare Administrative Contractors (MAC) Regional Carrier, Certificate of Medical Necessity and Supporting Documentation	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-847	CMS-847 -- OSTEOGENESIS STIMULATORS	CMS847.pdf	Yes	No	Fillable Fileable
Form and Instruction	CMS-846	CMS-846 -- PNEUMATIC COMPRESSION DEVICES	CMS846.pdf	Yes	No	Fillable Fileable
Form and Instruction	CMS-848	CMS-848 -- TRANSCUTANEOUS ELECTRICAL NERVE STIMULATOR (TENS)	CMS848.pdf	Yes	No	Fillable Fileable
Form and Instruction	CMS-849	CMS-849 -- SEAT LIFT MECHANISMS	CMS849.pdf	Yes	No	Fillable Fileable
Form and Instruction	CMS-854	CMS-854 -- CONTINUATION FORM	CMS854.pdf	Yes	No	Fillable Fileable
Form and Instruction	CMS-10125	CMS-10125 -- EXTERNAL INFUSION PUMPS	CMS10125.pdf	Yes	No	Fillable Fileable
Form and Instruction	CMS-10126	CMS-10126 -- ENTERAL AND PARENTERAL NUTRITION	CMS10126.pdf	Yes	No	Fillable Fileable
Form and Instruction	CMS-10269	POSITIVE AIRWAY PRESSURE (PAP) DEVICES FOR OBSTRUCTIVE SLEEP APNEA	CMS-10269.CPAP.doc	Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 59,200	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 90 %

	Approved	Previously Approved
Annual Number of Responses for this IC	6,480,000	6,480,000
Annual IC Time Burden (Hours)	1,296,000	1,296,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.