CMS-855O Application - Enrollment for Eligible Ordering/Certifying Physicians and Other Eligible Professionals

Do You Only Order or Certify Services? Use Revised Enrollment Form CMS-855O by January 1

The revised Enrollment for Eligible Ordering/Certifying Physicians and Other Eligible Professionals (Form CMS-855O) is required beginning January 1, 2023. We’ll post it on the CMS Forms List (https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-List ) by early fall.

Medicare Administrative Contractors will accept the current and revised versions of Form CMS- 855O through December 31, 2022. Visit the Medicare Provider Enrollment and Certification webpage (https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification) for more information.

Changes to the form include:

  • New title
  • Uniform language across all CMS 855 applications
  • Revised reporting requirements and formatting in Section 3: Final Adverse Legal Actions
  • 8 new specialties, including Adult Congenital Heart Disease
  • Corrections in response to public comments

 

Last Updated Sep 23 , 2022