CM Application 2012-2025

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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.
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 Centers for Medicare and Medicaid Services (CMS) was created to administer oversight of the Medicare Program and the federal portion of the Medicaid Program.
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.
What is the 855A? ❖ The Medicare Enrollment Application for Institutional Providers. ❖ This form is also used to submit changes to your enrollment data.
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