Provider Enrollment and Certification Ordering & Certifying
Guidance for Qualifying or Opting Out as an Ordering and Certifying Provider
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: August 31, 2020
Ordering providers can order non-physician services for patients. Referring providers can request items or services which Medicare may reimburse on behalf of Medicare beneficiaries.
To qualify as an ordering and certifying provider, you must:
- Have an individual National Provider Identifier (NPI)i
- Be enrolled in Medicare in either an “approved” or an “opt-out” status
- Be of an eligible specialty type
If you’re currently enrolled as a Medicare Part B provider, you can already order and certify. You don't need to re-enroll in Medicare.
Access the Ordering & Certifying Files
The Ordering & Certifying Files contain a list all providers who are currently eligble to order and certify. These files are only available on the CMS Data website.
Frequently Asked Questions
What if I don’t want to submit claims to Medicare for my services?
If you decide not to bill Medicare for your services, you can still order and certify by opting out of Medicare or enrolling solely to order and certify.
When you opt out or enroll as an ordering and certifying provider, Medicare coverage will apply when you order or certify:
- Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)
- Clinical Laboratory Services
- Imaging Services
- Home Health Services
Who can order and certify?
Items and services you can order and certify will depend on your specialty type. Contact your MAC (PDF) if you have questions about what you can order and certify.
Eligible specialty types include:
Physicians
- Doctors of medicine or osteopathy
- Doctors of dental medicine
- Doctors of dental surgery
- Doctors of podiatric medicine
- Doctors of optometry (Optometrists can only order DMEPOS supplies and laboratory or x-ray services payable under Medicare Part B.)
Non-Physician Practitioners
- Physician Assistants
- Clinical Nurse Specialists
- Nurse Practitioners
- Clinical Psychologists
- Interns, Residents, and Fellows
- Certified Nurse Midwives
- Clinical Social Workers.
i Organizational NPIs don't qualify and you can’t use them to order or certify.
Educational Material
- MLN Matters® article #SE1305 (PDF) Full Implementation of Edits on the Ordering/Referring Providers in Medicare Part B, DME and Part A Home Health Agency (HHA) Claims
- MLN Matters® article #MM8239 (PDF) Denial for Power Mobility Device (PMD) Claim from a Supplier of Durable Medical, Orthotics, Prosthetics, and Supplies (DMEPOS) When Ordered By a Non-Authorized Provider
- MLN Matters® article #SE1505 (PDF) Physicians and Non-Physician Practitioners Reported on Part A Critical Access Hospital (CAH) Claims
- Medicare Enrollment Guidelines for Ordering/Referring Providers (PDF)
- The Basics of Medicare Enrollment for Physicians Who Infrequently Receive Medicare Reimbursement (PDF)
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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.