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Last Modified: 5/14/2020 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 external pdf file, 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.
list item Please use your browser's back button to return to the referring page.
Source: CR 6417
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