Last Modified: 12/13/2017 Location: FL, PR, USVI Business: Part B
Eligibility requirements for ordering/referring providers FAQ
Q: What are the requirements for a provider to be eligible to order or refer items or services for a Medicare beneficiary?
A: According to the Centers for Medicare & Medicaid Services’ (CMS’) change request (CR) 6417 , a provider is eligible to order or refer items or services for a Medicare beneficiary only if he or she meets both of the following criteria:
• The ordering/referring provider must be enrolled in Medicare and have a current enrollment record in the Provider Enrollment, Chain and Ownerships System (PECOS).
• The ordering/referring provider must be classified as a provider who is eligible to order or refer:
• Doctor of medicine or osteopathy
• Dental medicine
• Dental surgery
• Podiatric medicine
• Physician’s assistant
• Certified clinical nurse specialist
• Nurse practitioner
• Clinical psychologist
• Certified nurse midwife
• Clinical social workers
Note: Only Medicare-enrolled physicians and non-physician practitioners that meet the above criteria are eligible to order/refer services for Medicare beneficiaries.
Please use your browser's back button to return to the referring page.
Source: CR 6417
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.