A provider is eligible to order or certify items or services for a Medicare beneficiary only if he or she meets both of the following criteria:

• The ordering or certifying provider must be enrolled in Medicare and have a current enrollment record in PECOS:
  • Billing providers (from the list below) who enrolled using the CMS-855I or non-billing providers (from the list below) who enrolled to solely order and certify using the CMS-855O
• The ordering or certifying provider must be classified as a provider who is eligible to order or certify:
  • Doctor of Medicine or Osteopathy (MD/DO)
  • Doctor of Dental Medicine (DMD)
  • Doctor of Dental Surgery (DDS) 
  • Doctor of Podiatric (DPM)
  • Doctor of Optometry (OD)
  • Certified Nurse Midwife (CNM) 
  • Clinical Nurse Specialist (CNS)
  • Clinical Psychologist (CP)
  • Clinical Social Worker (CSW)
  • Marriage and Family Therapist (MFT)
  • Mental Health Counselor (MHC)
  • Nurse Practitioner (NP) 
  • Physician Assistant (PA)  

You can verify your eligibility to order or certify beneficiary services by checking PECOS to ensure your enrollment record is current and includes your classification as a specialty or type of provider eligible to refer items or services for a Medicare beneficiary.

If you’re the billing provider, you can confirm the ordering or certifying provider’s eligibility by accessing CMS’ Ordering and referring data file on the CMS data website.