42 C.F.R. § 424.505
Basic enrollment requirement
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.)
Notes of Decisions
Cited in 12
cases (4 in the last 5 years), 2008–2025 · leading case: Consumers' Checkbook, Ctr. for the Study of Servs. v. United States Dep't of Health & Human Servs., 554 F.3d 1046 (D.C. Cir. 2009).
Consumers' Checkbook, Ctr. for the Study of Servs. v. United States Dep't of Health & Human Servs., 554 F.3d 1046 (D.C. Cir. 2009). “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.”
Ass'n of Am. Physicians & Surgeons, Inc. v. Sebelius, 901 F. Supp. 2d 19 (D.D.C. 2012). “42 C.F.R. §§ 424.505 , *40 424.510 (2012).”
Willie Goffney, Jr. v. Xavier Becerra, 995 F.3d 737 (9th Cir. 2021). “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, 742 F.3d 911 (9th Cir. 2014). “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 Servs., Inc., 643 F.3d 1103 (8th Cir. 2011). “See 42 C.F.R. §§ 424.505 , 424.510; Iowa Admin.”
In Re Vitalsigns Homecare, Inc., 396 B.R. 232 (Bankr. D. Mass. 2008). “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 (E.D. Wash. 2024). “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 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). “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 (W.D. Ark. 2020). “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 (D. Haw. 2019). “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 (S.D. Ohio 2020). “§§ 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 Hosp. & Healthcare Ass'n v. Roberts (E.D. Va. 2023). “See 42 C.F.R. § 424.505 (“To receive payment for covered Medicare items or services .”
Annotations are extracted automatically from the opinions in the
Syfert caselaw corpus and ranked by authority, recency, and
treatment. Dots show Syfertize treatment of the citing case itself.