OMB control number
Medicare Enrollment Application for Institutional Providers (CMS-855A)
OMB 0938-0685 · HHS/CMS.
OMB 0938-0685
The primary function of the CMS-855A Medicare enrollment application is to gather information from a certified provider or certified supplier (hereafter occasionally and collectively referenced as “provider(s)”) that tells us who it is, whether it meets certain qualifications to be a health care provider, where it practices or renders services, the identity of its owners, and other information necessary to establish correct claims payments.
The latest form for Medicare Enrollment Application for Institutional Providers (CMS-855A) expires 2027-09-30 and is listed under ICR 202408-0938-001.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form CMS-855A Medicare Enrollment Application for Institutional Providers | Form and Instruction |
| Form CMS-855A REH Completion of CMS-855A Change of Information | Form and Instruction |
 CMS-855A - Supporting Statement.docx | Supporting Statement A |
 Medicare Enrollment Application for Institutional Providers |
Form and Instruction |
| REH Completion of CMS-855A Change of Information |
Form and Instruction |
All Historical Document Collections
OMB Details
Medicare Enrollment Application for Institutional Providers
Federal Enterprise Architecture: Health - Health Care Services
| Form | Name | Electronic access | Type |
|---|---|---|---|
| Form CMS-855A | Medicare Enrollment Application - Institutional Providers | Fillable Fileable Signable | Form and instruction |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.