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Certificate of Medical Neccessity CMS 854 Continuation Form
INSTRUCTIONS FOR COMPLETING THE CERTIFICATE OF MEDICAL NECESSITY SECTION C CONTINUATION FORM CMS-854 To be completed by the supplier NARRATIVE DESCRIPTION OF EQUIPMENT COST Provide 1 a narrative description of the item s ordered as well as all options accessories 2 the product model and serial number of the product being delivered if applicable 3 the supplier s charge for each item option accessory and 4 the Medicare fee schedule allowance for each item/option/accessory/supply/drug if...
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