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Do You Only Order or Certify Services? Use Revised Enrollment Form CMS-855O by January 1

The revised Enrollment for Eligible Ordering/Certifying Physicians and Other Eligible Professionals (Form CMS-855O) is required beginning 1/1/2023. We’ll post it on the CMS Forms List by early fall.

MACs will accept the current and revised versions of Form CMS-855O through 12/31/2022. Visit the Medicare Provider Enrollment and Certification webpage for more information.

Changes to the form include:

  • New title
  • Uniform language across all CMS 855 applications
  • Revised reporting requirements and formatting in Section 3: Final Adverse Legal Actions
  • Eight new specialties, including adult congenital heart disease
  • Corrections in response to public comments

Posted 10/5/2022