Physicians

10.2.3.11 – Physicians (Rev. 13355; Issued: 08-13-25; Effective: 05-05-25; Implementation: 05-05-25) As described in § 1861(r)(1) of the Social Security Act and in 42 CFR § 410.20(b), a physician must be legally authorized to practice medicine by the state in which the individual performs such services in order to enroll in the Medicare program and to retain Medicare billing privileges. Such individuals include: (1) doctors of medicine or osteopathy, dental surgery or dental medicine, podiatric medicine, or optometry; and (2) a chiropractor who meets the qualifications specified in 42 CFR § 410.22. See Pub. 100-04, chapter 19, section 40.1.2 for special licensure rules regarding practitioners who work in or reassign benefits to hospitals or freestanding ambulatory care clinics operated by the Indian Health Service or by an Indian tribe or tribal organization.