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. § 424.520

Effective date of Medicare billing privileges

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(a) Surveyed, certified or accredited providers and suppliers. The effective date for billing privileges for providers and suppliers requiring State survey, certification or accreditation is specified in § 489.13 of this chapter. If a provider or supplier is seeking accreditation from a CMS-approved accreditation organization, the effective date is specified in § 489.13.

(b) Independent Diagnostic Testing Facilities. The effective date for billing privileges for IDTFs is specified in § 410.33(i) of this chapter.

(c) DMEPOS suppliers. The effective date for billing privileges for DMEPOS suppliers is specified in § 424.57(b) of this subpart and section 1834(j)(1)(A) of the Act.

(d) Additional provider and supplier types. (1) The effective date of billing privileges for the provider and supplier types identified in paragraph (d)(2) of this section is the later of—

(i) The date of filing of a Medicare enrollment application that was subsequently approved by a Medicare contractor; or

(ii) The date that the provider or supplier first began furnishing services at a new practice location.

(2) The provider and supplier types to which paragraph (d)(1) of this section applies are as follows:

(i) Physicians.

(ii) Non-physician practitioners.

(iii) Physician organizations.

(iv) Non-physician practitioner organizations.

(v) Ambulance suppliers.

(vi) Opioid treatment programs.

(vii) Part B hospital departments.

(viii) Clinical Laboratory Improvement Amendment labs.

(ix) Intensive cardiac rehabilitation facilities.

(x) Mammography centers.

(xi) Mass immunizers/pharmacies.

(xii) Radiation therapy centers.

(xiii) Home infusion therapy suppliers.

(xiv) Physical therapists.

(xv) Occupational therapists.

(xvi) Speech language pathologists.

[73 FR 69940, Nov. 19, 2008, as amended at 75 FR 50418, Aug. 16, 2010; 79 FR 72531, Dec. 5, 2014; 84 FR 63203, Nov. 15, 2019; 85 FR 70355, Nov. 4, 2020; 86 FR 62419, Nov. 9, 2021]
Notes of Decisions
Cited in 4 cases (2 in the last 5 years), 2010–2023 · leading case: Willie Goffney, Jr. v. Xavier Becerra, 995 F.3d 737 (9th Cir. 2021).
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Willie Goffney, Jr. v. Xavier Becerra, 995 F.3d 737 (9th Cir. 2021). · cites it 3× “Goffney had filed a qualifying “enrollment application” and that the effective-date provision of 42 C.F.R. § 424.520 (d) controlled. The panel held that 42 C.”
Mahony v. Universal Pediatric Servs., Inc., 753 F. Supp. 2d 839 (S.D. Iowa 2010). “42 C.F.R. § 424.520 (b). Since it appears that UPSI would indeed have had up to ninety days to report a change, Mahony’s belief that UPSI was going to commit a false claim is not objectively reasonable.”
Ramaswamy v. Burwell, 83 F. Supp. 3d 846 (E.D. Mo. 2015). · cites it 5× “’ 42 C.F.R. § 424.520 (d) (emphasis added).”
Kline v. Docs at the Door, P.C. (N.D. Ill. 2023). “” 42 C.F.R. § 424.520 . Docs is vicariously liable for Ayeni’s actions based upon the privity between the two parties.”
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