Frequently Asked Questions

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FAQ

Why do I have to pay a Medicare enrollment application fee?

Section 6401(a) of the Affordable Care Act (ACA) requires the Secretary to impose a fee on each "institutional provider of medical or other items or services and suppliers." This includes groups and suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). The fee is to be used by the Secretary to cover the cost of program integrity efforts including the cost of screening associated with provider enrollment processes, including those under section 1866(j) and section 1128J of the Social Security Act. The application fee is currently $542 for CY2014; however, based upon provisions of the ACA this fee will vary from year-to-year based on adjustments made pursuant to the Consumer Price Index for Urban Areas (CPI-U).  The application fee is to be imposed on institutional providers, groups and DMEPOS suppliers that are newly-enrolling, re-enrolling/re-validating, or adding a new practice location.  CMS has defined "institutional provider" to mean any provider or supplier that submits a paper Medicare enrollment application using the CMS-855A, CMS-855B (except physician and non-physician practitioner organizations), or CMS-855S or the  associated Internet-based PECOS enrollment application.


(FAQ3131)

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