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Jurisdiction 1 Part B
Provider Enrollment

Provider Enrollment Resources:

  • Enroll, change your Medicare information, and add or delete group members or locations online at https://pecos.cms.hhs.gov. Print, sign and date the two-page Certification Statement, and mail the Certification Statement and all supporting paper documentation to Palmetto GBA Provider Enrollment within seven days of electronic submission.
  • Access CMS-855 forms then print, sign and mail them to Palmetto GBA
  • Palmetto GBA mailing addresses
  • Access the status of your CMS-855 application
  • Guidance on which form to complete
  • CMS file: providers eligible to order / refer and providers with current enrollment records
  • Contact the J1 Part B Provider Contract Center at (866) 931-3901 from 7 a.m. to 5 p.m. PST Monday through Friday for additional assistance on provider enrollment

Select a Topic:

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IDTF Table for CPT Codes 93875-G040008/30/2010
IDTF Table for CPT Codes 71010-7322308/26/2010
IDTF Table for CPT Codes 73500-7477508/26/2010
IDTF Table for CPT Codes 75557-7638008/26/2010
IDTF Table for CPT Codes 76506-7705908/26/2010
IDTF Table for CPT Codes 77072-7887608/26/2010
IDTF Table for CPT Codes 91000-9377008/26/2010
IDTF Table for CPT Codes A9500-Q996708/26/2010
Medicare Physicians and Non-Physician Practitioners: Protecting Your Privacy, Protecting Your Medicare Enrollment Record07/29/2010
Mailing To All Individual Practitioners, Medical Groups and Clinics and Independent Diagnostic Testing Facilities (IDTF) Who Are Billing or Have Billed For The Technical Component of Advanced Diagnostic Imaging Services07/14/2010
Opt Out Listing: Southern California07/13/2010
Opt Out Listing: Hawaii07/09/2010
Opt Out Listing: Nevada07/09/2010
Opt Out Listing: Northern California07/08/2010
How to Determine If You Are an Independent Diagnostic Testing Facility (IDTF)?05/04/2010
IDTF Table for CPT Codes 51725-7055505/04/2010
IDTF Table for CPT Codes 93875-G040005/04/2010
Updated: Independent Diagnostic Testing Facility Table02/10/2010
Verification of Legalized Status02/03/2010
CMS-855 Applications and Internet-based PECOS01/10/2010
Medicare Enrollment: Fact Sheets12/30/2009
Independent Diagnostic Testing Facilities: Availability of Mammography Codes12/14/2009
Effective Date Changes: Provider Enrollment Applications08/05/2009
Guidance on Using Internet-based Provider Enrollment, Chain and Ownership System (PECOS)08/05/2009
Opt Out of Medicare Provider Enrollment: Instructions07/10/2009
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last updated on 08/30/2010
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