Thank you for visiting First Coast Service Options' Medicare provider website. This website is intended exclusively for Medicare providers and health care industry professionals to find the latest Medicare news and information affecting the provider community.

To enable us to present you with customized content that focuses on your area of interest, please select your preferences below:

Select which best describes you: Health Care Professional Person(s) with Medicare

Select your location: Florida Puerto Rico U.S. Virgin Islands

Select your line of business: Part A Part B

By clicking Continue below you agree to the following:

LICENSE FOR USE OF "PHYSICIAN'S CURRENT PROCEDURAL TERMINOLOGY" (CPT), FOURTH EDITION End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2022 American Medical Association (AMA).

All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.
You, your employees, and agents are authorized to use CPT only as contained in the following authorized materials:
Local Coverage Determinations (LCDs),
Local Medical Review Policies (LMRPs),
Bulletins/Newsletters,
Program Memoranda and Billing Instructions,
Coverage and Coding Policies,
Program Integrity Bulletins and Information,
Educational/Training Materials,
Special mailings,
Fee Schedules;

internally within your organization within the United States for the sole use by yourself, employees and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare and Medicaid Services (CMS), formerly known as Health Care Financing Administration (HCFA). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Applications are available at the AMA website. Applicable FARS/DFARS restrictions apply to government use.

AMA Disclaimer of Warranties and Liabilities CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this agreement.

CMS Disclaimer: The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

AMA - U.S. Government Rights

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a )June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements.

ADA CURRENT DENTAL TERMINOLOGY, (CDT)
End User/Point and Click Agreement: These materials contain Current Dental Terminology (CDTTM), Copyright Â© 2016 American Dental Association (ADA). All rights reserved. CDT is a trademark of the ADA.

THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING ON THE BUTTON LABELED "ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.

IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK ON THE BUTTON LABELED "DECLINE" AND EXIT FROM THIS COMPUTER SCREEN.

IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING.

Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Applications are available at the ADA website.

Applicable Federal Acquisition Regulation Clauses (FARS)\Department of restrictions apply to Government Use.

ADA DISCLAIMER OF WARRANTIES AND LIABILITIES: CDT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CDT. The ADA does not directly or indirectly practice medicine or dispense dental services. The sole responsibility for the software, including any CDT and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. The ADA is a third party beneficiary to this Agreement.

CMS DISCLAIMER: The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT should be addressed to the ADA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

End Disclaimer

Home ► Provider enrollment applications and forms

Provider enrollment applications and forms

CMS-460 Medicare participating physician or supplier agreement pdf file

Modified: 11/7/2024

Participants agree to accept assignment for all covered services provided to Medicare patients. New physicians, practitioners, and suppliers may submit this form at the time of enrollment.

Submitting a provider enrollment appeal: Corrective action plan or reconsideration request

Modified: 3/25/2024

Learn how to submit a provider enrollment appeal in the form of a corrective action plan or reconsideration request.

Medicare enrollment forms

Modified: 8/14/2024

Forms, whether paper or electronic, must be completed by all providers of services and suppliers of medical and other health services for enrollment in the Medicare program. Find out what form is applicable for you.

Determining your Medicare effective date

Modified: 6/17/2024

Use this guide to help determine your Medicare effective date based on your applicable scenario(s).

Life cycle of an enrollment application

Modified: 5/24/2024

There are many steps that must take place to process an enrollment application. Learn about the high-level progression of a basic enrollment.

Required sections on CMS applications

Modified: 4/25/2024

Do you know what sections of the CMS enrollment applications you must complete? Review this article to learn more.

Internet-based PECOS external link

Modified: 4/17/2024

Find information about the Provider Enrollment, Chain and Ownership System (PECOS), the Centers for Medicare & Medicaid Services’ online enrollment process.

How to change or add a practice mailing address

Modified: 4/12/2024

All changes of practice addresses are reported on the applicable CMS-855 form. Find out what form is right for you.

CMS-855 enrollment application processing timeframes

Modified: 4/10/2024

Did you know CMS has defined timeframes for processing CMS-855 forms? Read on to learn more.

How do I voluntarily terminate or deactivate my Medicare enrollment?

Modified: 4/5/2024

Submit the applicable CMS-855 application to voluntarily terminate your Medicare enrollment or to deactivate your reassignment. Review this article to learn more.

New Medicare enrollment: Which forms do I need to complete?

Modified: 4/5/2024

New to Medicare? Enrollment forms must be completed by all providers of services and suppliers of medical and other health services for enrollment in the Medicare program. Find out what form is applicable for you.

Reporting requirements for a legal business name (LBN) change

Modified: 4/5/2024

When an individual practitioner or a group/organization experience a change to their legal name or LBN, this change should be reported to the Medicare contractor within 90 days. Review this article to learn more.

Provider enrollment decision tree

Modified: 3/29/2024

Review our decision tree to help determine if you should enroll as an individual in private practice, sole proprietor/disregarded entity, sole owner, or group practice/organization.

Top reasons for immediate returns of enrollment applications

Modified: 3/29/2024

Review this article to learn how to avoid an immediate return of an enrollment application.

CMS-588 electronic funds transfer

Modified: 4/23/2024

Providers are required to sign up for electronic funds transfer (EFT) using a CMS-588 EFT form upon initial enrollment in the Medicare program or when changing enrollment information.

Physicians and non-physician practitioners: Revised Medicare enrollment application required November 1

Modified: 5/3/2024

Effective November 1, 2023, you must use the revised CMS-855I (Medicare Enrollment Application - Physicians and non-physician practitioners) to enroll or update your information.

Clinical Laboratory Questionnaire pdf file

Modified: 4/18/2024

Use this questionnaire for assistance in determining if the referring laboratory may bill for tests performed by a reference laboratory.

Medicare enrollment for ‘mass immunizers’

Modified: 4/12/2024

An entity or individual who wishes to furnish mass immunization services - but may not otherwise qualify as a Medicare provider - may be eligible to enroll as a “mass immunizer.”

Enrolling and reporting changes

Modified: 3/22/2024

Access everything you need to know about initially enrolling or reporting changes to your Medicare enrollment.

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.