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This version of the form is not currently in use and is provided for reference only. Download this version of
Form CMS-855S
for the current year.
Form CMS-855S Medicare Enrollment Application - Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (Dmepos) Suppliers
What Is Form CMS-855S?
This is a legal form that was released by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services on November 1, 2021 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form CMS-855S?
A: Form CMS-855S is a Medicare Enrollment Application for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers.
Q: Who should use Form CMS-855S?
A: DMEPOS Suppliers should use Form CMS-855S to enroll in the Medicare program.
Q: What is the purpose of Form CMS-855S?
A: The purpose of Form CMS-855S is to collect information necessary to establish enrollment in the Medicare program as a DMEPOS supplier.
Q: What information is required on Form CMS-855S?
A: Form CMS-855S requires information about the supplier's business, ownership, and compliance with Medicare requirements.
Form Details:
- Released on November 1, 2021;
- The latest available edition released by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services;
- Easy to use and ready to print;
- Yours to fill out and keep for your records;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form CMS-855S by clicking the link below or browse more documents and templates provided by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services.
Download Form CMS-855S Medicare Enrollment Application - Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (Dmepos) Suppliers
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