CMS 484

Dynamic List Information
Dynamic List Data
Form #
CMS 484
Form Title
CERTIFICATE OF MEDICAL NECESSITY - Oxygen DME 484.5
Revision Date
2017-02-01
O.M.B. #
0938-0534
O.M.B. Expiration Date
2020-02-01
Special Instructions
This form must be used starting January 1, 2007.

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