Requirements for Establishing and Maintaining Medicare Billing Privileges

  1. Law
  2. CFR 42
  3. Public Health
  4. Centers for Medicare & Medicaid Services, Department of Health and Human Services
  5. Medicare Program
  6. Conditions for Medicare Payment
  7. Requirements for Establishing and Maintaining Medicare Billing Privileges

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Section
424.500

Scope.

Section
424.502

Definitions.

Section
424.505

Basic enrollment requirement.

Section
424.506

National Provider Identifier (NPI) on all enrollment applications and claims.

Section
424.507

Ordering covered items and services for Medicare beneficiaries.

Section
424.510

Requirements for enrolling in the Medicare program.

Section
424.514

Application fee.

Section
424.515

Requirements for reporting changes and updates to, and the periodic revalidation of Medicare enrollment information.

Section
424.516

Additional provider and supplier requirements for enrolling and maintaining active enrollment status in the Medicare program.

Section
424.517

Onsite review.

Section
424.518

Screening levels for Medicare providers and suppliers.

Section
424.519

Disclosure of affiliations.

Section
424.520

Effective date of Medicare billing privileges.

Section
424.521

Request for payment by certain provider and supplier types.

Section
424.522

Additional effective dates.

Section
424.525

Rejection of a provider's or supplier's application for Medicare enrollment.

Section
424.526

Return of a provider's or supplier's enrollment application.

Section
424.530

Denial of enrollment in the Medicare program.

Section
424.535

Revocation of enrollment in the Medicare program.

Section
424.540

Deactivation of Medicare billing privileges.

Section
424.545

Provider and supplier appeal rights.

Section
424.546

Deactivation rebuttals.

Section
424.550

Prohibitions on the sale or transfer of billing privileges.

Section
424.555

Payment liability.

Section
424.565

Overpayment.

Section
424.570

Moratoria on newly enrolling Medicare providers and suppliers.