CMS-855B: Medicare Enrollment Application for Clinics and Group Practices
The Medicare enrollment application for clinics, group practices, and certain other suppliers — the primary enrollment vehicle for medical practices that bill Part B.
Primary source
CMS-855B Form — CMS.gov →https://www.cms.gov/medicare/cms-forms/cms-forms/downloads/cms855b.pdf
Verified May 23, 2026 · This is the authoritative regulator URL. The summary below is a research aid; the linked source controls.
Additional sources
The CMS-855B is the Medicare enrollment application for clinics, group practices, and certain other suppliers (excluding individual physicians and DME suppliers). It covers initial enrollment, revalidation, change of information, voluntary termination, and reassignment of benefits.
Key sections: legal business name and TIN, ownership and management interests at 5% or more, adverse legal history disclosures (felonies, exclusions, terminations), practice locations, billing agencies, reassignment relationships, and authorized officials.
The form is the data feed into PECOS (Provider Enrollment, Chain, and Ownership System). Most submissions can be filed via the online PECOS interface rather than the paper form, but the substantive disclosures are identical.
Revalidation cycle: every 5 years for most enrollees, every 3 years for DMEPOS suppliers. Failure to revalidate by the deadline triggers deactivation, which interrupts billing.
Common rejection patterns: missing ownership disclosure for indirect owners at 5%+, missing W-9 supporting documentation, signatures by unauthorized officials, and addresses that fail USPS validation. The MAC's enrollment contractor reviews and either approves or issues a development request — most development requests carry a 30-day response window.
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Related regulations
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Related across the archive
- RegulationCMS-855A: Medicare Enrollment for Institutional ProvidersMedicare enrollment application for institutional providers including hospitals, CAHs, hospices, home health agencies, federally qualified health centers, rural health clinics, and similar entities.
- RegulationCMS-855I: Medicare Enrollment Application for Individual Physicians and Non-Physician PractitionersIndividual Medicare enrollment vehicle for physicians, NPPs, and certain other individual suppliers; required for any clinician billing Medicare under their own name.
- RegulationCMS-855R: Reassignment of Medicare BenefitsAuthorization form for an individual physician/NPP to reassign their right to collect Medicare payment to a group practice or other eligible entity.
- GlossaryCMS-855 (Medicare Enrollment Application)Family of Medicare enrollment applications: 855A (institutional), 855B (group), 855I (individual), 855O (ordering/referring), 855R (reassignment).
- GlossaryCAQH CredentialingThe CAQH ProView database used by most commercial payers to credential providers.
- GlossaryCredentialingThe process by which a payer verifies a provider's qualifications and grants participation in the network.
- GlossaryDeactivationRemoval of a provider from Medicare's enrollment file, typically for failing to revalidate, billing inactivity, or final adverse action.
- GlossaryHospital CredentialingThe process by which a hospital medical staff verifies and grants privileges to a physician.
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.