Change Request 6780 - cms-2025

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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.
Change of Ownership (CHOW) is defined in 42 CFR 489.18 (a) and generally means, in the case of a partnership, the removal, addition, or substitution of a partner, unless the partners expressly agree otherwise, as permitted by applicable State law.
Parts A and B make up Original Medicare. Part A covers many costs of inpatient care. Part B primarily covers the costs of outpatient treatment and preventive care, such as doctor visits, medical equipment, and some prescriptions.
Clinics, group practices, and other suppliers can apply for enrollment in the Medicare program or make a change in their enrollment information using either: The Internet-based Provider Enrollment, Chain and Ownership System (PECOS), or The paper CMS-855B enrollment application.
CMS-855B: For organization (all applicable sections). CMS-855I: For reassigning individuals who are new to the Medicare program, or not PECOS enrolled (sections 1, 2, 3, 4B, 13, and 15).
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Remember: if you move your office location, you must complete the appropriate CMS-855/CMS-20134 form to update your Medicare address information. The form must bear a handwritten signature of the physician / non-physician practitioner or of the group / organizations authorized or delegated official.
CMS-855B: For organization (all applicable sections). CMS-855I: For reassigning individuals who are new to the Medicare program, or not PECOS enrolled (sections 1, 2, 3, 4B, 13, and 15). CMS-855I: For employed physician assistants (sections 1, 2, 3, 13, and 15).
A change request in ACO-MS refers to adding new information or changing existing information in ACO-MS that may require CMS approval.

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