CMSCMS Enrollment

CMS-855A: Medicare Enrollment for Institutional Providers

Medicare enrollment application for institutional providers including hospitals, CAHs, hospices, home health agencies, federally qualified health centers, rural health clinics, and similar entities.

Primary source

CMS-855A Form — CMS.gov

https://www.cms.gov/medicare/cms-forms/cms-forms/downloads/cms855a.pdf

Verified May 23, 2026 · This is the authoritative regulator URL. The summary below is a research aid; the linked source controls.

The CMS-855A is the Medicare enrollment application for institutional providers — Part A providers including hospitals, critical access hospitals (CAHs), skilled nursing facilities, home health agencies, hospices, comprehensive outpatient rehabilitation facilities (CORFs), end-stage renal disease facilities, federally qualified health centers (FQHCs), rural health clinics (RHCs), religious nonmedical health care institutions, and outpatient physical/occupational therapy/speech-language pathology providers.

Key sections: legal business and DBA names, TIN, type of organization (proprietary, nonprofit, government, religious), CCN if applicable, Medicare survey/accreditation status (CMS region, state agency, deemed accrediting organization), services to be furnished, ownership and management at 5%+, practice locations, billing agencies, and adverse legal history.

Institutional providers undergo a CMS survey or deemed-status accreditation review as part of the conditions of participation/coverage. Enrollment cannot be completed until the survey or accreditation evidence is on file with the state survey agency.

Revalidation is every 5 years. Change of ownership requires a new application and triggers a Tie-In notice from the CMS Regional Office. Failure to file a CHOW timely is a recurring source of payment interruption.

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Last reviewed May 23, 2026 · Citation verified May 23, 2026

Research aid, not legal advice. This summary is an administrative research aid prepared by D3rx. It does not certify compliance, provide legal advice, replace counsel, or guarantee an audit outcome. For authoritative regulatory text follow the primary source link at the top of this page. The practice remains responsible for reviewing, adopting, and maintaining its compliance program.