OMB control number
Durable Medical Equipment Medicare Administrative Contractors (MAC) Regional Carrier, Certificate of Medical Necessity and Supporting Documentation
OMB 0938-0679 · HHS/CMS.
OMB 0938-0679
This information is needed to correctly process claims and ensure that claims are properly paid. These forms contain medical information necessary to make an appropriate claim determination. Suppliers and physicians will complete these forms and as needed supply additional routine supporting documentation to process claims.
The latest form for Durable Medical Equipment Medicare Administrative Contractors (MAC) Regional Carrier, Certificate of Medical Necessity and Supporting Documentation expires 2023-06-30 and is listed under ICR 202002-0938-014.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form CMS-10126 Durable Medical Equipment Medicare Administrative Contractors (MAC) Regional Carrier, Certificate of Medical Necessity and Supporting Documentation | Form and Instruction |
| Form CMS-484 Oxygen and Supplies | Form and Instruction |
 CMS-484-10126 - Supporting Statement Part A.docx | Supporting Statement A |
| CMS-484-10126 - Appendix A - Response to Public Comments.pdf | Supplementary Document |
 Durable Medical Equipment Medicare Administrative Contractors (MAC) Regional Carrier, Certificate of Medical Necessity and Supporting Documentation |
Form and Instruction |
| Oxygen and Supplies |
Form and Instruction |
All Historical Document Collections
OMB Details
Durable Medical Equipment Medicare Administrative Contractors (MAC) Regional Carrier, Certificate of Medical Necessity and Supporting Documentation
Federal Enterprise Architecture: Health - Health Care Services
| Form | Name | Electronic access | Type |
|---|---|---|---|
| Form CMS-846 | CMS for PNEUMATIC COMPRESSION DEVICES | Fillable Fileable Signable | Form and instruction |
| Form CMS-854 | CMS-854 -- CONTINUATION FORM | Fillable Fileable | Form and instruction |
| Form CMS-10126 | CMN for ENTERAL AND PARENTERAL NUTRITION | Fillable Fileable Signable | Form and instruction |
| Form CMS-10125 | CMN for EXTERNAL INFUSION PUMPS | Fillable Fileable Signable | Form and instruction |
| Form CMS-849 | CMN for SEAT LIFT MECHANISMS | Fillable Fileable Signable | Form and instruction |
| Form CMS-848 | CMN for TRANSCUTANEOUS ELECTRICAL NERVE STIMULATOR (TENS) | Fillable Fileable Signable | Form and instruction |
| Form CMS-847 | CMN for OSTEOGENESIS STIMULATORS | Fillable Fileable Signable | Form and instruction |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.