CMS Pub. 100-08, ch. 10, § 10.4.6

A. Reactivations of Enrollment/Billing Privileges

1. Form CMS-855 or CMS-20134 Reactivations – Screening Levels

a. Limited

The contractor shall process reactivation applications from providers in the “limited” level of

categorical screening in accordance with existing instructions.

b. Moderate

The contractor shall process reactivation applications from providers in the “moderate” level of

categorical screening (including existing HHAs and DMEPOS suppliers) in accordance with the

screening procedures for this category. A site visit is thus needed prior to the contractor’s final

decision regarding the application.

c. High

The contractor shall process reactivation applications from providers in the “high” level of

categorical screening in accordance with the screening procedures for this category. A site visit

is thus needed prior to the contractor’s final decision regarding the application.

2. Form CMS-855B and CMS-855I Non-Certified Supplier Reactivations

If the contractor approves a Part B non-certified supplier’s reactivation application, the

reactivation effective date shall be the date the contractor received the application that was

processed to approval. In addition, upon reactivating a Part B non-certified supplier, the

contractor shall issue a new PTAN; for PECOS applications (and as indicated in section 10.3 of

this chapter), PECOS will automatically issue a new PTAN.

3. Form CMS-855A or CMS-855B Certified Provider or Supplier Reactivations

With the exception of HHAs, reactivation of a certified provider/supplier does not require a new

state survey, provider agreement, or participation agreement. Per 42 CFR § 424.540(b)(3)(i), an

HHA must undergo a new state survey or obtain accreditation by an approved accreditation

organization before it can be reactivated.

4. Reactivations - Deactivation for Reasons Other Than Non-Submission of a Claim

To reactivate its billing privileges, the provider or supplier must submit a complete Medicare

enrollment application if the provider or supplier was deactivated: (i) for failing to timely notify

the contractor of a change of information; or (ii) under § 424.540(a)(4) and (a)(5).

5. Reactivation Effective Date

Per 42 CFR § 424.540(d)(2), the effective date of a reactivation of billing privileges under this

section is the date on which the contractor received the provider’s or supplier’s reactivation

submission that the contractor processed to approval. Under 42 CFR § 424.540(e), however, the

provider or supplier may not receive payment for services or items furnished while deactivated.

This means that the contractor shall not add a retroactive back-billing period (e.g., 30 days) to

the reactivation effective date. To illustrate, suppose the contractor establishes a reactivation

effective date under § 424.540(d)(2) of October 30, the date the contractor received the

ultimately approved reactivation submission. The contractor under § 424.540(e) cannot establish

an effective date earlier than October 30 to allow for additional retroactive billing.

6. Miscellaneous Policies

a. Previous Withdrawn Status

A provider that voluntarily withdraws (or, in the case of a certified provider/supplier, voluntarily

or involuntarily withdraws from Medicare enrollment) is ineligible for reactivation. Such a

provider must complete an initial enrollment application and, if applicable, pay an application

fee.

b. Deactivation for Non-Billing

For providers deactivated for non-billing, the provider must submit a complete Form CMS-855

or CMS-20134 enrollment application via paper or PECOS Web.

c. Contractor Timeliness Standards

For Form CMS-855 or CMS-20134 reactivation applications, the timeliness requirements in

section 10.5 et seq. of this chapter pertaining to initial enrollment applications apply. Except as

otherwise stated in this chapter or another CMS directive, the contractor shall validate all of the

information on the application as it would with an initial application.

B. Ordering/Certifying Reactivations Under § 424.547

See section 10.4.8(B) of this chapter for information on reactivations of physicians/practitioners

whose ability to order/certify/refer the Medicare services and items identified in § 424.507(a)

and (b) were deactivated per § 424.547.