Customer Edit, Comment, CMN, C

Section C contains a blank space that can be formatted in different ways. However the following guidelines must be met:

The description of the item provided must include not only those items listed in Section A of the CMN, but also any accessories, options, supplies or drugs which are related to the item and which are provided by the supplier. There should be a narrative description for each related item billed on a separate claim line. The exact HCPCS description is not required; a reasonable, abbreviated descriptor may be substituted.
For every item listed, the supplier must always specify their submitted charge. For purchased equipment, accessories and options, the full charge must be specified. For rental equipment, accessories and options, the supplier must specify “per month” or “/month.” For accessories, supplies, nutrients, or drugs which are replaced regularly, the supplier must specify what time span the charge represents – e.g., per day, per week, per month, etc.
The supplier must list the Medicare fee schedule amount for each item, accessory and option, if applicable. The fee schedule allowance should reflect the same time span and quantity used in the submitted charge column. If the Medicare allowed amount is determined by methods other than a fee schedule (e.g., for drugs, parenteral and enteral nutrients, PEN supplies, miscellaneous codes, etc.), a NA (not applicable) should be put in the Medicare allowed charge column.