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Patient: Last Name:___ First Name___ Fitter: ___ Clinic ___ (example PT/OT/PTA) Date: Fitter Title:___ (example: PT/OT/PTA)info@stillmeinc.comDate:___Exo Custom Lower Extremity Measuring and Order
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How to fill out cms-846-pneumatic compression devices

01
Obtain the CMS-846 form for pneumatic compression devices.
02
Fill out the patient's name, date of birth, and address in the designated fields.
03
Specify the type of pneumatic compression device being prescribed.
04
Provide the start and end dates for the rental or purchase of the device.
05
Include the prescribing physician's information and signature.
06
Review the form for accuracy before submitting it to the relevant healthcare provider or insurance company.

Who needs cms-846-pneumatic compression devices?

01
Patients with conditions such as lymphedema, venous insufficiency, or chronic wounds that can benefit from pneumatic compression therapy.
02
Individuals recovering from surgery or injury who require additional support to improve circulation and reduce swelling.
03
Those at risk for developing blood clots or with circulatory issues that can be managed with the use of pneumatic compression devices.
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CMS-846 is a form used for reporting and requesting reimbursement for pneumatic compression devices, which are medical devices designed to help with circulatory problems and prevent deep vein thrombosis.
Healthcare providers and suppliers who prescribe or provide pneumatic compression devices to patients are required to file the CMS-846 form.
To fill out the CMS-846, providers must complete the form with patient information, device specifications, diagnosis codes, and any required signatures before submitting it to CMS or relevant payers.
The purpose of the CMS-846 form is to ensure proper documentation and reimbursement for the use of pneumatic compression devices, verifying their medical necessity for patients.
The CMS-846 requires reporting patient demographics, medical necessity diagnoses, healthcare provider information, and details about the pneumatic compression device.
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