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Back  RFI # 471: Length of Medical Necessity

Formal vs. Informal Help Informal Formal

Submitter

Ginger Wright

Description

On the 837p the SV503 Qty, Length of Medical Necessity element is required. Not all payers require DME Certificates of Medical Necessity and at the time the DME supplier is providing the rental and purchase info on the SV5 seg they do not know the length of MN. Should they not use this segment unless they know the length of MN? Please provide guidance on the use of this segment/field.

Submitter Assigned Keywords

SV503, DME

Response

The SV5 segment is only required when it is necessary to report BOTH the Rental and the Purchase Price on the claim for Durable Medical Equipment when a payer such as a Commercial Payer makes a Rent vs. Buy decision on DME. In those cases, SV503, Length of Medical Need, is required to determine if the equipment should be Rented or Purchased. SV503 is always required when SV5 is used.
Submission 10/19/2006
Status Date 1/3/2007
Status F - Final
Primary References
Document 004010X098A1
Section3
Page390
Set ID837
Table2
Loop2400
Segment Position400
Segment IDSV5
Element Position03
Industry NameLength of Medical Necessity