Medicare Form CMS-855A: The Complete 2026 Guide for Institutional Providers

Key Summary

The Medicare Form CMS-855A is the official enrollment application used by institutional providers — such as home health agencies, hospices, skilled nursing facilities, and hospitals — to apply for, update, or maintain participation in the Medicare program. In 2026, submitting a CMS-855A accurately is crucial for billing privileges, compliance with Centers for Medicare & Medicaid Services (CMS) requirements, and maintaining active status in PECOS (Provider Enrollment, Chain, and Ownership System). This guide explains who needs Form 855A, how to complete it, where to submit it, and what changes have been introduced for 2026.

What Is the Medicare Form CMS-855A?

Form CMS-855A is the official Medicare Enrollment Application for Institutional Providers. It is required by CMS for any organization that wishes to:

• Enroll as a new institutional provider under Medicare.
• Change ownership or management structure.
• Revalidate enrollment (every 3–5 years).
• Reactivate billing privileges after deactivation.
• Add new practice locations or services.

The form ensures that providers meet Medicare Conditions of Participation (CoPs) and are qualified to receive Medicare payments for covered services.

Who Must File Form CMS-855A

Institutional providers include any healthcare organization that provides inpatient or facility-based services and bills using the UB-04 (CMS-1450) claim form.

Provider Types That Must Use CMS-855A

• Home Health Agencies (HHAs)
• Hospices
• Skilled Nursing Facilities (SNFs)
• Hospitals (Acute Care, Psychiatric, Rehabilitation, etc.)
• Federally Qualified Health Centers (FQHCs)
• Rural Health Clinics (RHCs)
• Comprehensive Outpatient Rehabilitation Facilities (CORFs)
• End-Stage Renal Disease (ESRD) Facilities
• Critical Access Hospitals (CAHs)
• Community Mental Health Centers (CMHCs)

Note: Individual practitioners such as physicians, nurse practitioners, or therapists do not use Form 855A. They must use Form CMS-855I instead. 

When to Submit CMS-855A

You must submit Form CMS-855A when:

Timely submission of updates is essential — CMS requires reporting within 30 days for ownership or control changes and within 90 days for general information changes.

CMS-855A and PECOS

While CMS still accepts paper applications, most institutional providers in 2026 use PECOS (Provider Enrollment, Chain, and Ownership System) to complete Form 855A electronically.

Benefits of Using PECOS

• Faster processing time
• Real-time validation and error checking
• Ability to upload supporting documentation securely
• Electronic signature capability
• Easy revalidation and updates

The online version mirrors the paper form, ensuring consistency with CMS’s official enrollment requirements.

Sections of the CMS-855A Form

The form is extensive and divided into multiple sections. Below is a simplified overview of each part:

All fields must be completed accurately to avoid application delays or denials.

Supporting Documents Required

To complete the CMS-855A, you’ll need to attach:

• Copy of state license or certificate of need (CON) (if required)
• IRS letter showing the legal business name and Tax ID
• Accreditation certificate (e.g., CHAP, ACHC, or The Joint Commission)
• Articles of Incorporation or Operating Agreement
• Organizational chart and ownership structure
• Lease agreement or proof of ownership for the primary location
• Background check authorization for controlling parties
• Proof of NPI registration

Each Medicare Administrative Contractor (MAC) may have specific submission instructions, so always verify regional requirements.

How to Submit the CMS-855A

You can complete and submit the application in one of two ways:

Option 1: Online Submission via PECOS (Recommended)

1. Create or log in to your PECOS account.
2. Select “Institutional Provider (Form 855A).”
3. Complete each section electronically.
4. Upload required documents (PDF format).
5. Electronically sign the certification statement.

Option 2: Paper Submission

1. Download the most recent version of CMS-855A from CMS.gov.
2. Complete the application manually.
3. Mail the full packet to your regional MAC.
4. Retain a copy for your records.

Application Review and Approval Process

After submission, your application goes through several steps:

1. Initial Review: MAC verifies completeness and required documentation.
2. Background Screening: CMS conducts fingerprinting and ownership checks for high-risk providers.
3. Onsite Visit (if applicable): Home health and hospice agencies undergo site inspections.
4. Final Review: CMS confirms compliance with Medicare Conditions of Participation (CoPs).
5. Approval and Provider Number Issued: You’ll receive a Provider Transaction Access Number (PTAN) confirming Medicare enrollment.

Processing time typically ranges from 30 to 90 days, depending on provider type and risk level.

Common Mistakes to Avoid

To prevent delays, double-check all fields and ensure your legal name, TIN, and NPI match IRS and NPPES records.

CMS-855A Fees and Screening in 2026

All institutional providers must pay a Medicare application fee during enrollment and revalidation.

2026 Application Fee (Estimated): $740 (adjusted annually for inflation).

Payment must be made electronically via Pay.gov before submitting your CMS-855A.

Providers are also subject to CMS risk-based screening:

Revalidation of CMS-855A

CMS requires providers to revalidate every 3 to 5 years to maintain active billing privileges. You’ll receive a notice by mail or PECOS.

During revalidation, you must:

• Update all business and ownership details.
• Confirm or update practice locations.
• Pay the revalidation fee.
• Submit the application online through PECOS.

Failing to revalidate by the deadline can result in billing privilege deactivation.

Frequently Asked Questions (FAQ)

1. What’s the difference between CMS-855A and CMS-855B?

CMS-855A is for institutional providers (like home health agencies), while CMS-855B is for group practices or organizations of individual practitioners.

2. Can I submit CMS-855A updates electronically?

Yes, all updates, changes, or revalidations can be submitted via PECOS for faster processing.

3. How do I find my Medicare Administrative Contractor (MAC)?

You can locate your MAC by visiting CMS.gov/Medicare-Contracting.

4. Do I need accreditation before submitting CMS-855A?

Yes. Home health and hospice agencies must be accredited and meet state licensure requirements prior to CMS certification.

5. What happens if I fail to update CMS-855A after an ownership change?

Your billing privileges may be suspended or revoked, and payments can be withheld until CMS records are updated.

Final Thoughts

The CMS-855A form is the foundation of Medicare participation for institutional providers. Whether you’re opening a new home health agency, acquiring an existing facility, or revalidating your status, this form ensures that your organization meets federal standards for reimbursement and compliance.

To simplify the process:

• Complete your PECOS enrollment online.
• Upload all required licenses, ownership documents, and accreditation certificates.
• Track your application with your MAC and respond quickly to any requests.

For detailed instructions, visit the CMS 855A Enrollment Guide on CMS.gov and review your Medicare Administrative Contractor’s enrollment resources.

By keeping your enrollment current and accurate, your agency ensures uninterrupted billing privileges and full compliance with CMS requirements in 2026.

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