February 15, 2021
Oxygen Certificate of Medical Necessity Certification Chart
CGS designed the Oxygen Certificate of Medical Necessity Certification Chart to assist suppliers in determining when an initial, recertification, or revised Certificate of Medical Necessity CMS-484-Oxygen form is required.
The chart provides a quick desk reference and lists the requirements in an easy-to-read format, which highlights the main factors in determining which type of CMN is needed. Links to the Local Coverage Determination (LCD) [L33797] and Policy Article [A52514] are provided for reference.