This state-specific form must be completed by the doctor and/or speech therapist.

Documentation from a doctor which Medicare requires before it will cover certain durable medical equipment. The CMN states the patient's diagnosis, prognosis, reason for the equipment, and estimated duration of need.

Essential tool for determining coverage; form used requires documentation of patient's physiological need for specified DME POS services; required by Medicare or Third Party Payor to substantiate reason for payment of claim; contains patient ID, diagnosis, and reasons why the DME/HME item (e.g.; wheelchair) is medically necessary