Form Cms-855s - Medicare Enrollment Application - Durable Medical Equipment, Prosthetics, Orthotics, And Supplies (Dmepos) Suppliers

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MEDICARE ENROLLMENT APPLICATION
Durable Medical Equipment, Prosthetics, Orthotics,
and Supplies (DMEPOS) Suppliers
CMS-855S
SEE PAGE 1 FOR A LIST OF THE DMEPOS SUPPLIER STANDARDS. TO ENROLL IN THE MEDICARE
PROGRAM AND BE ELIGIBLE TO SUBMIT CLAIMS AND RECEIVE PAYMENTS, EVERY DMEPOS SUPPLIER
APPLICANT MUST MEET AND MAINTAIN THESE ENROLLMENT STANDARDS.
SEE PAGE 2 TO DETERMINE IF YOU ARE COMPLETING THE CORRECT APPLICATION.
SEE PAGE 4 FOR INFORMATION ON WHERE TO MAIL THIS APPLICATION.
SEE SECTION 12 FOR A LIST OF SUPPORTING DOCUMENTATION TO BE SUBMITTED WITH THIS
APPLICATION.
TO VIEW YOUR CURRENT MEDICARE ENROLLMENT RECORD GO TO:
HTTPS://PECOS.CMS.HHS.GOV

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Parent category: Medical