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Code of Federal Regulations (Last Updated: May 6, 2024) |
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Title 42 - Public Health |
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Chapter IV - Centers for Medicare & Medicaid Services, Department of Health and Human Services |
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SubChapter B - Medicare Program |
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Part 424 - Conditions for Medicare Payment |
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Subpart P - Requirements for Establishing and Maintaining Medicare Billing Privileges |
§ 424.505 - Basic enrollment requirement.
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§ 424.505 Basic enrollment requirement.
To receive payment for covered Medicare items or services from either Medicare (in the case of an assigned claim) or a Medicare beneficiary (in the case of an unassigned claim), a provider or supplier must be enrolled in the Medicare program. Except for those suppliers that complete the CMS-855O form or CMS-identified equivalent, successor form or process for the sole purpose of obtaining eligibility to order or certify Medicare-covered items and services; once enrolled the provider or supplier receives billing privileges and is issued a valid billing number effective for the date a claim was submitted for an item that was furnished or a service that was rendered. (See 45 CFR part 162 for information on the National Provider Identifier and its use as the Medicare billing number.)
[71 FR 20776, Apr. 21, 2006, as amended at 79 FR 72531, Dec. 5, 2014]