Before DOL will reimburse oxygen, a hospital bed, a wheelchair or home nursing for a black lung beneficiary, the treating physician must request prior approval on this certification. It records the pulmonary condition, the equipment or service prescribed, the requested duration, and recent pulmonary function and arterial blood gas results. If granted, authorization lasts up to one year and is renewed through a recertification.
The treating physician completes the form and must sign and date item 13, certifying medical necessity for the covered pulmonary condition. A physician who is not the patient's regular or active treating doctor explains why in item 13b.
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Certification of Medical Necessity
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If granted, the authorization covers a maximum of one year. Equipment and home nursing must be reviewed yearly or at the expiration date, using a new CM-893 marked as a recertification (renewal) in item 8a, with supporting test results dated within 2 months of the prescription.
Yes. DCMWC's CMN FAQ says the form can be submitted even if the supplier of the equipment or service is not yet known. To be paid directly, the supplier must be an actively enrolled OWCP provider; suppliers that have never enrolled can register through the OWCP Connect portal.
DCMWC returns prescriptions for indefinite services or those without required objective test data. If a request is rejected because the patient's condition does not meet DOL's reimbursement standards, the physician may submit other medical evidence supporting the prescription, and all evidence will be considered.