US · guidance
CMS Pub. 100-08, ch. 10, § 10.3.1.5
Form CMS-855O – Medicare Enrollment Application for Eligible
Ordering and Certifying Physicians, and other Eligible Professionals
(Rev. 13355; Issued: 08-13-25; Effective: 05-05-25; Implementation: 05-05-25)
This form is used by physicians and other eligible professionals who wish to enroll in Medicare
solely for the purpose of ordering and certifying the services/items described in 42 CFR §
424.507(a) and (b). These physicians and other eligible professionals do not and will not send
claims to a contractor for the services they furnish. In addition, suppliers who have opted out of
Medicare are not permitted to enroll via the Form CMS-855O for purposes of ordering or
certifying.
The physician/other eligible professional need not submit a Form CMS-460, a Form CMS-588,
or an application fee with the Form CMS-855O.
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
3289b509fb60370cd259c106b8c17153594946bd37d638298dbc4f2627dd3483
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