Form CMS-853, Certificate of Medical Necessity, is the form used to document the necessity of medical equipment used for enteral nutrition. The form - also known as the "Сertificate of Medical Necessity (CMN) Form" - was issued by the Centers for Medicare and Medicaid Services (CMS), a component of the U.S. Department of Health and Human Services.
The last revision of the document was on April 1, 1996. The form is not available for download from RegInfo, but is active and still in use. Download printable Form CMS-853 through the link below.
The CMN-853 Form is used to document the medical necessity of the selected durable medical equipment, orthotics, prosthetics, and supplies items. The document may be used in support of a medical need and as a substitute for a written order. For the form to be recognized as a physician's detailed written order, the narrative description in Section C must be sufficiently explained, including quantities needed, frequency of replacement, nutrients, supplies, and drugs. To be valid, the form must display the current OMB number.
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