Order, Certify and/or Prescribe Part D Drugs

Overview

Ordering, Certifying and Prescribing Physicians and Other Eligible Professionals

  • Enroll solely to order, certify and prescribe items or services for Medicare Beneficiaries
  • Will not receive reimbursement for services
  • Is not currently enrolled to receive reimbursement for services
    • Providers already enrolled to bill for services may:
      • Bill for services rendered
      • Order and Certify items or services
      • Prescribe Part D drugs
  • Only required to be enrolled in one state
  • Wants to prescribe Part D prescription drugs and has not Opted Out
    • If social security number (SSN) and National Provider Identifier (NPI) is not on Opt Out Affidavit, provider is not enrolled to order, certify and/or prescribe services
    • If SSN and NPI is on Opt Out Affidavit, provider is enrolled to order, certify and prescribe Part D drugs
  • Can change status from Ordering, certifying and Prescribing to billing for services by completing an Initial Enrollment
    • Unless provider will no longer be billing for services rendered, do not submit CMS-855O application 
  • Only required to submit an application to order and certify, Enroll for Reimbursement or an Opt Out Affidavit to be eligible to prescribe Part D drugs
  • Must submit CMS-855O application via Internet-based PECOS or via paper 

Listing

View a list of specialties able to order certify and prescribe Part D drugs.

The most up to date list of individual providers with an approved ordering/certifying/prescribing enrollment in Medicare is the CMS list of ordering/ certifying/prescribing practitioners. Verify active enrollment to order/certify/prescribe in Medicare in CMS National Ordering, Certifying, and Prescribing Database.

  • If provider NPI is listed
    • Provider is eligible to order/certify
    • Provider is eligible to prescribe Part D drugs
    • No application is necessary
  • If provider NPI is not listed
    • Provider is not eligible to order/certify
    • Beneficiary will be denied for Part D drugs prescribed at point of sale on CMS established date
    • Submit CMS-855O application via Internet-based PECOS or via paper
  • If provider NPI is not listed but has an active I enrollment, contact the Provider Enrollment Contact Center
    • Tell the representative the national database was checked

Providers may log into CMS Internet-based PECOS to verify or change enrollment information at any time. Such updates include changes from ordering/referring to billing of services.

Make Changes

Changes to be made to a provider's Ordering/Certifying/Prescribing enrollment must be sent to the original MAC the provider applied with.

If changes are not sent to the original MAC, the application will be returned to the provider.

Tips

  • Ordering/Certifying means that providers want to order services for a Medicare beneficiary or refer them to another provider for services and will not receive reimbursement for services rendered
  • If a provider enrolls as an ordering, certifying, and prescribing provider, the provider has chosen not to submit services to Medicare for reimbursement
  • If enrolled as an ordering/certifying provider, provider is eligible to prescribe Part D drugs 
  • To become an ordering/certifying/prescribing provider, provider must obtain an NPI
  • To enroll as an ordering, certifying and prescribing provider, provider must complete and submit a CMS-855O form
    • One CMS-855O application will enroll a provider into nationwide program and carries over between all states

Last Updated Mar 13, 2018