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. § 424.505

Basic enrollment requirement

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To receive payment for covered Medicare items or services from either Medicare (in the case of an assigned claim) or a Medicare beneficiary (in the case of an unassigned claim), a provider or supplier must be enrolled in the Medicare program. Except for those suppliers that complete the CMS-855O form or CMS-identified equivalent, successor form or process for the sole purpose of obtaining eligibility to order or certify Medicare-covered items and services; once enrolled the provider or supplier receives billing privileges and is issued a valid billing number effective for the date a claim was submitted for an item that was furnished or a service that was rendered. (See 45 CFR part 162 for information on the National Provider Identifier and its use as the Medicare billing number.)

[71 FR 20776, Apr. 21, 2006, as amended at 79 FR 72531, Dec. 5, 2014]
Notes of Decisions
Cited in 12 cases (4 in the last 5 years), 2008–2025 · leading case: Consumers' Checkbook, Center for the Study of Services v. United States Department of Health & Human Services
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Consumers' Checkbook, Center for the Study of Services v. United States Department of Health & Human Services (2009) cadc · cites it 4× “42 C.F.R. §§ 424.505 , 424.510. The term "supplier" refers to "a physician or other practitioner, or an entity other than a provider, that furnishes health care services under Medicare.”
Association of American Physicians & Surgeons, Inc. v. Sebelius (2012) dcd · cites it 3× “42 C.F.R. §§ 424.505 , *40 424.510 (2012).”
Willie Goffney, Jr. v. Xavier Becerra (2021) ca9 “42 C.F.R. § 424.505 . (The statute distinguishes between hospitals, which it calls “providers,” and physicians, whom it calls “suppliers,” but because nothing in this case turns on that distinction, we will refer to both as providers.”
United States v. Alexander Popov (2014) ca9 “42 C.F.R. § 424.505 . Medicare may pay the claim in whole or in part, or deny the claim in whole or in part.”
Mahony v. UNIVERSAL PEDIATRIC SERVICES, INC. (2011) ca8 · cites it 2× “See 42 C.F.R. §§ 424.505 , 424.510; Iowa Admin.”
In Re Vitalsigns Homecare, Inc. (2008) mab “6 Once enrolled, the provider is issued a valid billing number, 42 C.F.R. § 424.505 , and may commence submitting claims for reimbursement of covered goods and/or services under the Medicare program.”
White v. Becerra (2024) waed · cites it 2× “500 ; 42 C.F.R. § 424.505 . The 11 Secretary administers the Medicare program through the Centers for Medicare and 12 Medicaid Services (“CMS”).”
In re: Prospect Medical Holdings, Inc., et al. v. Robert F. Kennedy, Jr., in his official capacity as Secretary, United (2025) txnb · cites it 2× “51 A hospital may request to participate in the Medicare program, but must meet the conditions of participation, including the statutory definition of a “hospital,”52 which is defined as an institution that “is primarily engaged in providing .”
Tomlinson v. Azar (2020) arwd “42 C.F.R. §§ 424.505 , 424.510. The Secretary of Health and Human Services determines who is eligible to participate in the Medicare program.”
Foo, M.D. v. Azar II (2019) hid “500 ; 42 C.F.R. § 424.505 . The Secretary administers the Medicare program through the Centers for Medicare and Medicaid Services (“CMS”).”
Golden Home Health Care, LLC v. Verma (2020) ohsd “§§ 1395x(u), 1395cc(a); 42 C.F.R. §§ 424.505 , 489.10. A provider of services must meet the Medicare conditions of participation applicable to that provider.”
Virginia Hospital & Healthcare Association v. Roberts (2023) vaed “See 42 C.F.R. § 424.505 (“To receive payment for covered Medicare items or services .”
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