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The following forms can be used for initial enrollment, revalidations, changes in status, and voluntary termination: CMS-855A (PDF) for Institutional Providers. CMS-855B (PDF) for Clinics, Group Practices, and Certain Other Suppliers. CMS-855I (PDF) for Physicians and Non-Physician Practitioners.
Clinics, group practices, and other suppliers can apply for enrollment in the Medicare program or make a change in their enrollment information using either: The Internet-based Provider Enrollment, Chain and Ownership System (PECOS), or. The paper CMS-855B enrollment application.
CMS 855S. Form Title. Medicare Enrollment Application - Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers. Revision Date. 2023-12-01. O.M.B. #. 0938-1056. O.M.B. Expiration Date. 2025-12-31.
CMS-855S. See page 1 for a list of the DMEPOS supplier standards. To enroll in the medicare program and be eligible to submit claims and receive payments, every DMEPOS supplier applicant must meet and maintain these enrollment standards. See page 2 to determine if you are completing the correct application.
Institutional providers can apply for enrollment in the Medicare program or make a change in their enrollment information using either: The internet-based Provider Enrollment, Chain and Ownership System (PECOS), or. The paper CMS-855A enrollment application.
The CMS-855R (Reassignment of Medicare Benefits) form has been discontinued. For additional information regarding the Medicare enrollment process (including Internet-based PECOS) and to get the current version of the CMS-855I, go to CMS.gov/Medicare/Provider-Enrollment-and-Certification.
You’re required to revalidate—or renew—your enrollment record periodically to maintain Medicare billing privileges. In general, providers and suppliers revalidate every five years but DMEPOS suppliers revalidate every three years. CMS also reserves the right to request off-cycle revalidations.
The following provides access and/or information for many CMS forms. You may also use the "Search" feature to more quickly locate information for a specific form number or form title.
Learn how to initially enroll, revalidate, and submit changes of information for suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Cover all aspects of completing the CMS-855S with a walkthrough of both the paper and PECOS versions of the form.
Learn how to initially enroll, revalidate, and submit changes of information for individual providers. Cover all aspects of completing the CMS-855I & 855R with a walkthrough of both the paper and PECOS versions of the form. Learn how to avoid common mistakes when submitting the 855-I&R. •.