C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 424—CONDITIONS FOR MEDICARE PAYMENT › Subpart P—Requirements for Establishing and Maintaining Medicare Billing Privileges

42 C.F.R. § 424.500

Scope

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The provisions of this subpart contain the requirements for enrollment, periodic resubmission and certification of enrollment information for revalidation, and timely reporting of updates and changes to enrollment information. These requirements apply to all providers and suppliers except for physicians and practitioners who have entered into a private contract with a beneficiary as described in part 405, subpart D of this chapter. Providers and suppliers must meet and maintain these enrollment requirements to bill either the Medicare program or its beneficiaries for Medicare covered services or supplies.

Notes of Decisions
Cited in 4 cases (3 in the last 5 years), 2019–2025 · leading case: Foo, M.D. v. Azar II (D. Haw. 2019).
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Foo, M.D. v. Azar II (D. Haw. 2019). “202 ; 42 C.F.R. § 424.500 ; 42 C.F.R. § 424.505 .”
United States of Am. v. Healthcare Assocs. of Texas LLC (N.D. Tex. 2023). “See 42 C.F.R. §§ 424.500 , 424.505. Further, nothing in the 2AC makes it obvious that the services were rendered “incident to” the named physicians’ care or under their supervision, which would permit billing to their NPIs.”
White v. Becerra (E.D. Wash. 2024). “202 ; 42 C.F.R. § 424.500 ; 42 C.F.R. § 424.505 .”
In re: Prospect Med. Holdings, Inc., et al. v. Robert F. Kennedy, Jr., in his Off. capacity as Sec'y, United States Dep't of Health & Human Servs.; & Mehmet Oz, in his Off. capacity as Adm'r, Ctr. for Medicare & Medicaid Servs. (Bankr. N.D. Tex. 2025). “58 The Secretary may terminate a provider agreement upon reasonable notice to the provider,59 and a failure to meet the definition of a “hospital” as defined under section 1395x(e) of the Medicare Act is one of the specified bases for which CMS may terminate a provider…”
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