Application Fee

Any provider/supplier that submits a CMS 855A form (via paper or web) to initially enroll, add a practice location or to revalidate are required to submit an application fee, including but not limited to:

  • Federally Qualified Health Centers
  • Community Mental Health Centers
  • Comprehensive Outpatient Rehabilitation Facilities
  • Critical Access Hospitals
  • End State Renal Dialysis Facilities
  • Home Health Agencies
  • Hospices
  • Hospitals
  • Opioid Treatment Program
  • Organ Procurement Organizations
  • Outpatient PT/OT/Speech Path Services
  • Religious Non-medical Health Care Institutions
  • Rural Health Clinics
  • Skilled Nursing Facilities

The fee must be submitted electronically via credit card, debit card or check. No paper checks will be accepted. Providers will print their payment receipt from and submit that with their application. Visit the following website to make a payment:

If providers/suppliers don't feel they can pay this fee, they are allowed to submit a hardship exception request. This request MUST accompany the application (paper form or with a certification statement if using PECOS web) or a fee will be required instead. The contractors will review that request and approve or deny it. Any hardship exception requests received separately from an application will not be considered and the provider will be required to submit a fee.

If the hardship exception request is denied, the provider/supplier has two options:

  1. The provider/supplier will have 30 days to submit their application fee or their application will be rejected or revoked.
  2. Provider/Suppliers may appeal this denial within 60 calendar days of the receipt of the decision letter. The appeal request should be sent to:

    Centers for Medicare & Medicaid Services
    Center for Program Integrity
    Provider Enrollment & Oversight Group
    7500 Security Boulevard
    Mailstop: AR-18-50
    Baltimore, MD 21244-1850


Last Updated Jan 10 , 2022