Ordering & Referring Information

Important Update on PECOS & Ordering/Referring

At this time CMS has not turned on the automated edits that would deny claims for services that were ordered or referred by a physician or other eligible professional simply for lack of an approved file in PECOS. CMS is working diligently to resolve backlog and other systems issues and will provide ample advance notice to the provider and beneficiary communities before CMS begins any such automatic denials. While there are some rumors that the edits will be turned on in January, we want to reiterate that CMS has not announced any date (January 3 or otherwise) as to when ordering/referring edits will be turned on.

Physicians or other eligible professionals not currently enrolled in PECOS should take the initiative to enroll sooner rather than later. There are three (3) ways to verify that you have an enrollment record in PECOS:

1. Check the Ordering and Referring Report in the "Downloads" Section below. If you are listed on that report, you have a current enrollment record in PECOS.
2. Use Internet-based PECOS to look for your PECOS enrollment record. If no record is displayed, you do not have an enrollment record in PECOS. A link to our Internet-based PECOS page is listed as the fourth (4th) link in the navigation menu on the left side of this screen.
3. Contact your designated Medicare enrollment contractor and ask if you have an enrollment record in PECOS. In order to identify your Medicare enrollment contractor, please visit our Medicare Provider and Supplier Enrollment "Overview" page and locate the download entitled "Medicare Fee-For-Service contact Information" in the downloads section. A link to the our Medicare Provider and Supplier Enrollment "Overview" page is listed first in the navigation menu located on the left side of this screen.

If you are not yet in PECOS and/or would like to enroll in the Medicare program, the best way to submit your application is through Internet-based PECOS. For more information, please visit our Internet-based PECOS page listed as the fourth (4th) link in the navigation menu on the left side of this screen

About the Ordering and Referring Files

The downloads below contain the National Provider Identifier (NPI) and legal name (last name, first name) of all physicians and non-physician practitioners who are of a type/specialty that is legally eligible to order and refer in the Medicare program and who have current enrollment records in Medicare (i.e., they have enrollment records in PECOS). 

A new file will be made available periodically that will replace the posted file; at any given time, only one file (the most recent) will be available. The file can be downloaded by users with technical expertise and further sorted or manipulated. It can also be used to search for a particular physician or non-physician practitioner by NPI or by name. Please note the following: (1) Records are in alphabetical order based on the surname of the physician or non-physician practitioner. (2) Name suffixes (e.g., Jr.), if they exist, are not displayed. (3) There are no “duplicates” in the file. Many physicians or non-physician practitioners share the same first and last name; their corresponding NPIs are the assurance of uniqueness. (4) Deceased physicians and non-physician practitioners are not included in the file.

There are two file formats for the Medicare Ordering and Referring File below. The first is a PDF format. This file will allow a user to verify that an individual physician or eligible professional has an approved enrollment record in PECOS using Adobe Acrobat Reader. The second file is a ZIP file. The ZIP file contains the same information as the PDF, however, the file is a CSV format. The CSV file will allow users to open the Ordering and Referring data in Excel, Notepad and other software formats that could be easier for users to search/sort. 

In order to use the CSV file, please left-click on the "Medicare Ordering and Referring File [ZIP, 64400KB]" and save the CSV document contained in the zipped download. Right-click on the saved CSV file, select "Open  With" on the task bar and select the program through which you would like open the Medicare Ordering and Referring File. 

Users must have the most recent version of Adobe Acrobat Reader and/or Excel in order to open the PDF and/or CSV file. 

The new Initial Physician and Non-Physician Applications Pending Contractor Review files are lists of applications pending contractor review. These pending applications have NOT been processed by the CMS contractors. These lists have been compiled to allow individuals the ability to verify that an application has been submitted and is awaiting processing.

The downloads below are the most recent versions of the O&R file. For a specific create date, please review each document individually. 

Educational Material

• MLN Matters® article #SE1221 Phase 2 of Ordering and Referring Requirement
• MLN Matters® article #SE1011 Edits on the Ordering/Referring Providers in Medicare Part B, DME and Part A HHA Claims
• Medicare Enrollment Guidelines for Ordering/Referring Providers
• The Basics of Medicare Enrollment for Physicians Who Infrequently Receive Medicare Reimbursement