According to the 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 or referring provider must be enrolled in Medicare and have a current enrollment record in the PECOS.
• The ordering or 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
  • Optometry
  • 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 or refer services for Medicare beneficiaries.

You can verify your eligibility to order or refer beneficiary services by checking the internet-based PECOS to ensure your enrollment record is current and includes your classification as a specialty or type of provider eligible to refer items or services for a Medicare beneficiary.

If you’re the billing provider, you can confirm the ordering or referring provider’s eligibility by accessing CMS’ Ordering and referring data file on the CMS data website.