Medicare Provider Enrollment Application Fee Decision Tree Tool

Question 1 - Is the application for one of the following provider types?

Physician
Nonphysician Practitioner
Clinic/Group Practice
Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services Provider that Enrolls and Bills Part B/CMS-855B
Medicare Diabetes Prevention Program (MDPP)

Yes No

Question 2 – Is the application for one of the following provider types?

Ambulance Service Supplier
Ambulatory Surgical Center
Community Mental Health Center
Comprehensive Outpatient Rehabilitation Facility
Critical Access Hospital
End-Stage Renal Disease Facility
Federally Qualified Health Center
Histocompatibility Laboratory
Home Health Agency
Home Infusion Therapy (HIT)
Hospice
Hospital
Independent Clinical Laboratory
Independent Diagnostic Testing Facility
Indian Health Services Facility
Intensive Cardiac Rehabilitation (ICR)
Mammography Center
Mass Immunization (Roster Biller Only)
Organ Procurement Organization
Opioid Treatment Program (OTP)
Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services Provider that Enrolls and Bills Part A/CMS-855A
Pharmacy
Portable X-ray Supplier
Radiation Therapy Center
Religion Non-Medical Health Care Institution
Rural Health Clinic
Skilled Nursing Facility

Yes No

Decision: Application Fee is NOT Required.

Question 3 – Is the reason for the application one of the following?

Initial Enrollment
Revalidation
Addition of Practice Location

Yes No

Decision: Application Fee is Required.

Go to the Provider Enrollment Chain & Ownership (PECOS) website to pay the fee:

Enter the required information and follow instructions to submit payment.
A confirmation screen will appear indicating payment was successfully made.
Print or save the confirmation/receipt for your records and you may also want to submit that receipt with your application as proof of payment.
- Applicants submitting via paper may attach receipt as a supporting document.
- Applicants using PECOS may upload the receipt as a supporting document.

If you believe you qualify for a hardship exception, you may write a letter that explains the hardship and why that hardship justifies an exception and supply any supporting documentation.

Applicants submitting via paper must include the letter and supporting documentation with the application.
Applicants using PECOS must upload the letter and any supporting documents.

Question 4 – Is the reason for the application a change of ownership requiring the provider/supplier to enroll as a new provider/supplier under Part A/CMS-855A?

Yes No

Decision: Application Fee is Required.

Go to the Provider Enrollment Chain & Ownership (PECOS) website to pay the fee:

Enter the required information and follow instructions to submit payment.
A confirmation screen will appear indicating payment was successfully made.
Print or save the confirmation/receipt for your records and you may also want to submit that receipt with your application as proof of payment.
- Applicants submitting via paper may attach receipt as a supporting document.
- Applicants using PECOS may upload the receipt as a supporting document.

If you believe you qualify for a hardship exception, you may write a letter that explains the hardship and why that hardship justifies an exception and supply any supporting documentation.

Applicants submitting via paper must include the letter and supporting documentation with the application.
Applicants using PECOS must upload the letter and any supporting documents.

Decision: The Application is for a Change of Information and Application Fee is NOT Required.