Ordering & Certifying

Ordering & Certifying
What if I don’t want to submit claims to Medicare for my services?

If you decide not to bill Medicare for your services, you can opt out of Medicare or enroll solely to order and certify.

When you opt out or enroll as an ordering and certifying provider, Medicare coverage will apply when you order or certify:

  • Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)
  • Clinical Laboratory Services
  • Imaging Services
  • Home Health Services

If you’re currently enrolled as a Medicare Part B provider, you can already order and certify. You do not need to re-enroll in Medicare.

To qualify as an ordering and certifying provider, you must:
  • Have an individual National Provider Identifier (NPI)i
  • Be enrolled in Medicare in either an “approved” or an “opt-out” status
  • Be of an eligible specialty type

Contact your Medicare Administrative Contractor (MAC) (PDF) to see if you qualify. You can view enrollment instructions for ordering and certifying providers on the Become a Medicare Provider or Supplier page.

Access the Ordering & Certifying Files

The files can ONLY be accessed at https://data.cms.gov. You can download the files in different formats (CSV, PDF, XLS, XLSX or XML).

  • Ordering and Certifying – lists all physicians and non-physician practitioners with current Medicare enrollment records in PECOS who are eligible to order and certify Part B (clinical laboratory and imaging), DME, and HHA items and services.
  • Pending Initial Physician and Non-Physician – list applications pending MAC review. The MACs have not finalized these applications.
  • Power Mobility Device (PMD) – lists all physicians and non-physician practitioners with current Medicare enrollment records in PECOS who are eligible to order and certify PMD.
  • Attending and Rendering - lists all physicians and non-physician practitioners with current Medicare enrollment records in PECOS who are eligible as attending or rendering providers on CAH Method II claims.

To find a file, search on “Order and Referring,” “Pending Initial L and Ts Physician,” “Pending Initial L and Ts Non-Physicians,” “PMD,” or “Attending and Rendering.” The files are displayed using the NPI and legal name (last name, first name).

Please note the following:

  • Name suffixes (e.g., “Jr.”) are not displayed.
  • There are no duplicates in the file. Many physicians and non-physician practitioners share the same first and last name; each unique NPI assures that nobody is included more than once.
  • Deceased physicians and non-physician practitioners are not included in the file.

CMS updates the reports twice a week to keep the information up to date. At any given time, only the most current report will be available for exporting. Users with technical expertise can further sort or manipulate the file after exporting it. It can also be used to search for a particular physician or non-physician practitioner by NPI or by name.

Who can order and certify?

Please note: items and services you can order and certify will depend on your specialty type. Contact your MAC if you have questions about what you can order and certify.

Eligible specialty types include:

  • Physicians
    • Doctors of medicine or osteopathy
    • Doctors of dental medicine
    • Doctors of dental surgery
    • Doctors of podiatric medicine
    • Doctors of optometry (Optometrists can only order DMEPOS supplies and laboratory or x-ray services payable under Medicare Part B.)
  • Physician Assistants
  • Clinical Nurse Specialists
  • Nurse Practitioners
  • Clinical Psychologists
  • Interns, Residents, and Fellows
  • Certified Nurse Midwives
  • Clinical Social Workers.
 

i Organizational NPIs do not qualify and you can’t use them to order or certify.

Educational Material
Page Last Modified:
08/31/2020 09:55 AM