To enroll in the medicare program and be eligible to submit claims and receive payments, every DMEPOS supplier applicant must meet and maintain these enrollment standards.
Changes: any change to your existing enrollment data must be reported within 30 days of the effective date of the change.
Revalidation: do not submit an application for revalidation until you have been contacted by the contractor.
Signatures: all signatures must be original and in ink. Faxed, photocopied, or stamped signatures will not be accepted.
Legible: type or print all information so that it is legible. Do not use pencil. Blue ink is preferred.
| Question | Answer |
|---|---|
| Form Name | CMS-855S |
| Form Length | 39 pages |
| Fillable? | Yes |
| Fillable fields | 1031 |
| Avg. time to fill out | 60+ min |
| Edition | 12/23 |
| Issuing agency | Department of Health and Human Services, Centers for Medicare & Medicaid Services |
| Where to send | Your designated contractor, Novitas Solutions (NPEAST) or Palmetto GBA (NPWEST), based on your geographic location |
| Matches the agency's file | Yes, checked October 2, 2026 |
| Other names | CMS-855S, CMS855S, 855S, 855S form, CMS 855S, Medicare 855S, CMS-855S form, Medicare Enrollment Application DMEPOS Suppliers |
| Official source | CMS-855S (Rev 12/23), Centers for Medicare & Medicaid Services |
Form Cms 855S isn’t the one you’re looking for?