Form CMS-855O – Medicare Enrollment Application for Eligible

10.3.1.5 – Form CMS-855O – Medicare Enrollment Application for Eligible Ordering and Certifying Physicians, and other Eligible Professionals (Rev. 13355; Issued: 08-13-25; Effective: 05-05-25; Implementation: 05-05-25) This form is used by physicians and other eligible professionals who wish to enroll in Medicare solely for the purpose of ordering and certifying the services/items described in 42 CFR § 424.507(a) and (b). These physicians and other eligible professionals do not and will not send claims to a contractor for the services they furnish. In addition, suppliers who have opted out of Medicare are not permitted to enroll via the Form CMS-855O for purposes of ordering or certifying. The physician/other eligible professional need not submit a Form CMS-460, a Form CMS-588, or an application fee with the Form CMS-855O.