Physicians and Nonphysician Practitioners: Revised CMS-855I Medicare Enrollment Application Required November 1 (Combined CMS-855I and CMS-855R)

If you don’t use PECOS, use the revised CMS-855I (Medicare Enrollment Application - Physicians and Nonphysician Practitioners) to enroll or update your information. MACs will accept current and revised versions of the form through 10/31/2023. Starting 11/1/2023, you must use the revised form CMS-855I (05/23)

Form updates:

• Combines the CMS-855I and CMS-855R paper applications and discontinues the CMS-855R
• Moves physician assistant employer arrangements to the reassignment section
• Recognizes physicians and nonphysicians who provide acupuncture services
• Identifies compact licenses
• Adds new physician specialties
• Expands practice location types to include telehealth

Visit Medicare Enrollment for Providers & Suppliers for more information, including a CMS-855I instructional guide. To enroll and update your information more quickly and easily, use PECOS.

Visit our website for information located at:

• Education: Help and FAQs (Enrollment)
• Enrollment: Submit Enrollment Application Using Paper
  • Initial Provider Enrollment Process
  • Change Existing Provider Enrollment Information
  • Revalidating Your Enrollment
• Enrollment: Helpful Tips
• YouTube Video and Events: Completing the CMS-855I Paper Application

Revised 10/16/2023