US · guidance
CMS Pub. 100-08, ch. 10, § 10.2.3.11
Physicians
As described in § 1861(r)(1) of the Social Security Act and in 42 CFR § 410.20(b), a
physician must be legally authorized to practice medicine by the state in which the
individual performs such services in order to enroll in the Medicare program and to retain
Medicare billing privileges. Such individuals include: (1) doctors of medicine or
osteopathy, dental surgery or dental medicine, podiatric medicine, or optometry; and (2) a
chiropractor who meets the qualifications specified in 42 CFR § 410.22.
See Pub. 100-04, chapter 19, section 40.1.2 for special licensure rules regarding
practitioners who work in or reassign benefits to hospitals or freestanding ambulatory care
clinics operated by the Indian Health Service or by an Indian tribe or tribal organization.
History
(Rev. 13355; Issued: 08-13-25; Effective: 05-05-25; Implementation: 05-05-25)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
1ff27832683aab4d85e19ee14e2a7d43167e75e0632f88bc0e4de39ae9ac3ada
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