US · guidance
CMS Pub. 100-22, ch. 1, § 20
Eligible Professionals
As defined in section 1848(k)(3)(B) of the Act, eligible professional means any of the following:
1. Physicians
• Doctor of Medicine
• Doctor of Osteopathy
• Doctor of Podiatric Medicine
• Doctor of Optometry
• Doctor of Dental Surgery
• Doctor of Dental Medicine
• Doctor of Chiropractic
2. Practitioners
• Physician Assistant
• Nurse Practitioner
• Clinical Nurse Specialist
• Certified Registered Nurse Anesthetist (and Anesthesiologist Assistant)
• Certified Nurse Midwife
• Clinical Social Worker
• Clinical Psychologist
• Registered Dietician
• Nutrition Professional
• Audiologists (as of 1/1/2009)
3. Therapists
• Physical Therapist
• Occupational Therapist
• Qualified Speech-Language Therapist (began billing Medicare directly as of
7/1/09)
Audiologists were added to the definition of “eligible professional” beginning with the 2009
Physician Quality Reporting System as required by section 131(b)(4) of the MIPPA.
5
All Medicare-enrolled professionals in these categories are eligible to participate in the Physician
Quality Reporting System, regardless of whether the professional has signed a Medicare
participation agreement to accept assignment on all claims.
History
(Rev. 10, Issued: 07-27-12, Effective: 10-29-12, Implementation: 10-29-12)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
40a9c0a84356312a5cf25f5c5a9525b6db1a168a23857af165adbb2a3200059e
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