Medicare provider revalidation is the process every enrolled provider and supplier goes through to confirm that the information on file with CMS is still accurate. Most providers revalidate every five years. Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers revalidate every three. You submit the same CMS-855 application you used to enroll, respond by the due date your Medicare Administrative Contractor (MAC) assigns, and keep billing without interruption. Miss the deadline and CMS can deactivate your billing privileges, creating a payment gap you cannot recover after the fact.
When You Have to Revalidate
The revalidation cycle runs from the date CMS processes your enrollment. Physicians, non-physician practitioners, hospitals, home health agencies, group practices, and most other provider types sit on a five-year cycle. DMEPOS suppliers revalidate every three years because CMS classifies them as a higher program-integrity risk.1eCFR. 42 CFR 424.515 – Requirements for Reporting Changes and Updates to, and the Periodic Revalidation of Medicare Enrollment Information
CMS can also pull any provider into an off-cycle revalidation at any time, regardless of where you sit in your regular schedule. This tends to happen when CMS identifies compliance concerns or when an enrollment moratorium is lifted for a particular provider category.
How to Find Your Due Date
CMS publishes revalidation due dates six to seven months in advance through the Medicare Revalidation List. You can search by NPI, name, state, or organization. If your due date is further out than six months, the tool displays “TBD” rather than a specific date.2Centers for Medicare & Medicaid Services. Medicare Revalidation List
Your MAC will send a revalidation notice by email or postal mail roughly three to four months before the deadline. That notice is a courtesy, not the source of truth. You are responsible for knowing your due date whether or not the notice arrives. If you are within three months of your due date and no notice has shown up, submit anyway.
Do not submit early. CMS returns unsolicited revalidations received more than seven months before the due date.3Centers for Medicare & Medicaid Services. Revalidations (Renewing Your Enrollment)
What Goes Into the Application
Revalidation uses the same CMS-855 forms as initial enrollment. Which one you complete depends on your provider type:
- CMS-855I — individual physicians and non-physician practitioners.4Centers for Medicare & Medicaid Services. CMS-855I Medicare Enrollment Application – Physicians and Non-Physician Practitioners
- CMS-855B — clinics, group practices, and other organizational suppliers.5Centers for Medicare & Medicaid Services. CMS-855B Medicare Enrollment Application – Clinics/Group Practices and Other Suppliers
- CMS-855A — institutional providers such as hospitals, skilled nursing facilities, and home health agencies.
- CMS-855O — providers who only order or refer and do not bill Medicare directly.
One change trips up returning providers. If you reassign benefits to a group practice, that reassignment is now handled inside the CMS-855I itself. The old standalone CMS-855R has been discontinued.4Centers for Medicare & Medicaid Services. CMS-855I Medicare Enrollment Application – Physicians and Non-Physician Practitioners
Every submission requires the National Provider Identifier (NPI) for all relevant parties, obtained through the National Plan and Provider Enumeration System (NPPES).6Centers for Medicare & Medicaid Services. Medicare Enrollment for Providers and Suppliers Your NPI data in NPPES must match what CMS has in PECOS. Mismatches between the two systems are a frequent cause of processing delays and claim denials, so verify NPPES before you file.7Centers for Medicare & Medicaid Services. Medicare Provider Enrollment
You will also disclose the Social Security Number or Employer Identification Number for every individual or entity holding a five percent or greater ownership interest, along with identifying information for managing employees such as board members and department heads. Any final adverse legal actions — license revocations, billing privilege suspensions, felony convictions — must be reported. Electronic funds transfer details are handled separately on Form CMS-588, which confirms that Medicare payments reach the correct bank account.8Centers for Medicare & Medicaid Services. Form CMS-588 – Electronic Funds Transfer Authorization Agreement
The Application Fee and Who Is Exempt
Institutional providers and certain suppliers must pay an application fee when enrolling, revalidating, or adding a new practice location. For 2026, the fee is $750, adjusted annually based on the Consumer Price Index.9Federal Register. Provider Enrollment Application Fee Amount for Calendar Year 2026 Payment goes through pay.gov; CMS does not accept paper checks outside that system.10Centers for Medicare & Medicaid Services. Pay.gov Frequently Asked Questions
Individual physicians and non-physician practitioners filing a CMS-855I are exempt from the fee entirely.7Centers for Medicare & Medicaid Services. Medicare Provider Enrollment The fee applies to institutional providers (hospitals, home health agencies, skilled nursing facilities), DMEPOS suppliers, and opioid treatment programs, among others. Physician organizations and Medicare Diabetes Prevention Program suppliers are also exempt.
How to Submit
The internet-based Provider Enrollment, Chain, and Ownership System (PECOS) is the preferred method. PECOS applications process faster than paper submissions, accept electronic signatures, and tailor each application to your provider type so you only see questions that apply to you.11Centers for Medicare & Medicaid Services. Manage Your Enrollment CMS targets completion of most PECOS revalidations within 15 business days when no site visit is needed.
Paper remains available. Complete the correct CMS-855 and mail it to your assigned MAC. Processing takes longer, and applications requiring a site visit or fingerprinting can run well beyond the 15-day target regardless of method.
Reporting Changes Between Revalidations
Revalidation is periodic, but the obligation to keep your information current is continuous. Federal regulation sets two reporting windows depending on the type of change:
- Within 30 days — a change of ownership or control (including changes to authorized or delegated officials), any final adverse legal action, or a change, addition, or deletion of a practice location.12eCFR. 42 CFR 424.516 – Additional Provider and Supplier Requirements for Enrolling and Maintaining Active Enrollment Status in the Medicare Program
- Within 90 days — all other enrollment changes, including contact information, non-managing staff, or banking details.12eCFR. 42 CFR 424.516 – Additional Provider and Supplier Requirements for Enrolling and Maintaining Active Enrollment Status in the Medicare Program
The clock runs from the date the change occurs, not the date you learn it must be reported. Thirty days goes fast when multiple parties have to coordinate around an ownership transfer or office move, so the safest approach is to build reporting into the operational checklist for those events. Failure to report within the window is itself grounds for revocation, not just deactivation.13eCFR. 42 CFR 424.535 – Revocation of Enrollment in the Medicare Program
What Happens if You Miss the Deadline
CMS can deactivate your Medicare billing privileges if you fail to respond to a revalidation request within 90 days, fail to report enrollment changes within the required timeframe, or stop billing Medicare for an extended period.14eCFR. 42 CFR 424.540 – Deactivation of Medicare Billing Privileges Deactivation is administrative rather than punitive, but it is not costless.
While deactivated, you cannot be paid for any services or items furnished to Medicare beneficiaries. There is no retroactive billing once you reactivate. The effective date of reactivation is the date your MAC received your reactivation submission, not the date you were deactivated. Everything in between is a permanent gap.14eCFR. 42 CFR 424.540 – Deactivation of Medicare Billing Privileges
To reactivate, you recertify that your enrollment information on file is still correct and supply anything missing. CMS can also require a complete new CMS-855 at its discretion. Home health agencies face an added hurdle: a deactivated HHA must obtain a new initial state survey or accreditation before billing can resume.
When Missing a Deadline Becomes Revocation
Revocation is a different matter from deactivation. It terminates your Medicare enrollment and bars you from re-enrolling for a set period. Grounds include felony convictions within the preceding ten years, submitting false information on an enrollment application, letting someone else use your billing number, patterns of billing for services not furnished, and failing to comply with reporting requirements.13eCFR. 42 CFR 424.535 – Revocation of Enrollment in the Medicare Program
The re-enrollment bar for a first offense runs from one to ten years depending on severity. A second revocation can carry a bar of up to 20 years. If CMS finds a provider trying to circumvent an existing bar by enrolling under a different name or business identity, it can add up to three more years on top. One narrow exception applies: if the revocation was based solely on failure to respond to a revalidation request, no re-enrollment bar attaches.
If You Receive a Deactivation or Revocation Notice
The type of adverse action controls the deadline for responding.
A deactivation can be challenged by written rebuttal within 15 calendar days of receiving the notice. The rebuttal must identify the specific facts you dispute, explain your reasons, and include supporting documentation, and it must be signed by the individual provider, an authorized or delegated official, or a legal representative.15eCFR. 42 CFR 424.546 – Deactivation Rebuttals Miss the 15-day window or file an incomplete rebuttal and you waive your rebuttal rights.
Revocations and enrollment denials carry formal appeal rights under 42 CFR Part 498. No payment is made during the appeal, but if you overturn a revocation, you can resubmit unpaid claims for services furnished during the overturned period.16eCFR. 42 CFR 424.545 – Provider and Supplier Appeal Rights That possibility of retroactive claim recovery is a meaningful difference from deactivation, where the payment gap stands regardless of outcome.