Certificate of Medical Necessity requirements for home infusion therapy program

The home infusion therapy program requires a Certificate of Medical Necessity for each therapy type, with a dated physician signature within 90 days of the start-of-care date. Each CMN must meet the guideline requirements as stated in the HIT manual, with no exceptions.

A CMN lasts 120 days. When the therapy is ordered beyond the 120-day limit, the CMN must be renewed with all the required information and signed within 90 days of the renewal date.

The pharmacist may take a verbal order related to the drug therapy without a physician co-signature; however a CMN renewal must be signed by the ordering physician within 90 days of the renewal date. Claims can’t be billed until the physician returns the signed and dated CMN to the infusion provider.

If the patient is hospitalized or admitted to a nursing home, the current CMN is automatically discontinued. The patient will need a new CMN when he or she returns to service. When the current services are discontinued and a new service is started, a new CMN is needed. An order change of the same therapy type during a 120-day CMN limit doesn’t need a new CMN.

The major therapy types are specified by the Healthcare Common Procedure Coding System, as indicated below:

Failure to meet these requirements may result in an audit recovery. If you have any questions, contact your provider consultant.