Last Modified: 11/23/2018 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.
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Source: CR 6417
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