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CMS-855B (Rev. 03/2021) 1. WHO SHOULD SUBMIT THIS APPLICATION. Clinics, group practices, and other suppliers must complete this application to enroll in the Medicare program and receive a Medicare billing number.
Medicare Enrollment Application: Institutional Providers (CMS-855A): Institutional providers use this form to start the Medicare enrollment or revalidation process, or to change enrollment information.
The 855b is used for Diabetic Education and Mass Immunization while the 855s is for Durable Medical Equipment and non-accredited drugs.
What is the 855B? ❖ The CMS form used for the enrollment of Clinic/Group practices and Certain Other Suppliers. This form is also used to submit changes to your enrollment data.
All physicians, as well as all eligible professionals as defined in section 1848(k)(3)(B) of the Social Security Act must complete this application to enroll in the Medicare program and receive a Medicare billing number.

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Reactivation of Billing Privileges Otherwise, to reactivate enrollment billing privileges submit a completed CMS-855A and CMS-588 paper application or submit electronically via PECOS. Submit a copy of a voided check or bank confirmation letter with the CMS-588.

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