How Institutional Providers Will Pay the Medicare Enrollment Application Fee Beginning March 25, 2011

Section 6401(a) of the Affordable Care Act (ACA) requires the secretary to impose a fee on each 'institutional provider of medical or other items or services and suppliers.' The fee is to be used by the secretary to cover the cost of program integrity efforts including the cost of screening associated with provider enrollment processes, including those under section 1866(j) and section 1128J of the Social Security Act. Based upon provisions of the ACA, this fee will vary from year-to-year based on adjustments made pursuant to the Consumer Price Index - All Urban Consumers (CPI-U). The application fee is to be imposed on institutional providers that are newly-enrolling, re-enrolling/re-validating or adding a new practice location for applications received on and after Friday, March 25, 2011. CMS has defined 'institutional provider' to mean any provider or supplier that submits a paper Medicare enrollment application using the CMS-855A, CMS-855B (except physician and non-physician practitioner organizations), or CMS-855S forms or associated Internet-based PECOS enrollment application. 

Institutional providers applying to participate in the Medicare program must first submit a completed CMS-855 application. An enrollment application can be submitted in one of two ways:

  1. Electronically, using Internet-based PECOS: Once you have completed and submitted your enrollment application using Internet-based PECOS, you should then promptly pay the application fee. The Medicare contractor will process the provider enrollment application in the order in which it was received. Normal processing time frames apply to your provider enrollment application.
  2. Complete the paper Medicare enrollment application (CMS-855): Once you have completed filling out the CMS-855 paper application, you should promptly pay the application fee through Internet-based PECOS. The Medicare Contractor will process your provider enrollment application in the order in which it was received. Normal processing timeframes apply to your provider enrollment application.  

For more information, please refer to the regulation published to the Federal Register (PDF, 735 KB)

Last Updated: 12/20/2017