Enrollment in Medicare

Get started in the federal health insurance program for people age 65 or older and younger people with disabilities.

Apply to become a Medicare provider in 3 steps

  1. Obtain your National Provider Identifier (NPI)
  2. Complete the Medicare enrollment application via PECOS
  3. Select your specialty designation

Step 1: Obtain an NPI

Before enrolling in Medicare, you need an NPI.

First, you must get an Identity and Access Management System user account. Then, you can apply for an NPI.

How to Apply

Step 2: Complete the Medicare enrollment application

Once you have your NPI, complete the Medicare Enrollment Application through Medicare’s online enrollment system known as the Provider Enrollment, Chain, and Ownership System (PECOS)opens in new window.

Although PECOS is designed to be paperless, providers can print a copy of the application for their records. PECOS will indicate if additional documentation is needed and includes the name and address of the Medicare Administrative Contractor (MAC) that should receive the documentation.

In addition to processing new Medicare enrollment applications, and tracking the status of a submitted application, PECOS can also be used by existing Medicare providers to update enrollment information, complete the revalidation process, and withdraw from the Medicare program.

If you cannot use PECOS, a paper copy of the enrollment application—Form CMS-855I (PDF, 486KBopens in new window)—can be completed and mailed with your supporting documents.

To reassign benefits to another entity, use Form CMS-855.

Mail completed forms to your MAC; the address will be provided during the application process.

Medicare does not charge an application fee for psychologists to enroll.

 

Step 3: Select a specialty designation

Psychologists applying for a Medicare provider number must choose a specialty from the two psychologist designations used by CMS. Psychologists may apply as an independently practicing psychologist (specialty code 62) or clinical psychologist (specialty code 68). Independently practicing psychologists can only furnish diagnostic testing services, whereas clinical psychologists can provide diagnostic and therapeutic services. The vast majority of psychologists in the Medicare program are designated as clinical psychologists.

More on Medicare

Independently Practicing Psychologist
(Specialty Code 62)

Recommended for: Psychologists who only conduct diagnostic psychological and neuropsychological testing services 

Who qualifies
  • Render services on their own responsibility, free of the administrative and professional control of any employer such as a physician, institution, or agency
  • Treats own patients independently
  • Has the right to bill directly, collect, and retain fees for their services
  • Licensed in the state or jurisdiction where they furnish services
What you can do
  • Provide diagnostic testing services only when ordered by a physician, clinical psychologist, or nonphysician practitioner who is authorized to order diagnostic tests
Important limitations
  • Cannot provide therapy or treatment services through Medicare
  • Diagnostic testing must be ordered by a physician, clinical psychologist, or nonphysician practitioner
  • Not authorized to supervise diagnostic psychological and neuropsychological testing
  • Typically held by master’s-level psychologists

Medicare covers diagnostic testing as an outpatient service if furnished by an independently practicing psychologist who is licensed or certified to practice psychology in the state or jurisdiction where he or she is furnishing services. For jurisdictions that do not issue licenses, such as some of the trust territories, any practicing psychologist may furnish services as an independently practicing psychologist.

Clinical Psychologist
(Specialty Code 68)

Recommended for: Psychologists who provide therapy and comprehensive psychological services. Most psychologists choose this designation.

Who qualifies
  • Holds a doctoral degree in psychology (i.e., PhD, EdD, PsyD)
  • Licensed or certified by their state at the independent practice level of psychology, to furnish diagnostic, assessment, preventative, and therapeutic services directly to individuals
  • Can provide diagnostic, assessment, preventive, and therapeutic services
  • Is eligible to order/refer services and opt out of Medicare
What you can do
  • Perform diagnostic psychological and neuropsychological testing (no physician order required)
  • Supervise diagnostic testing
  • Must agree to consult with patient’s primary care or attending physician

It is important to understand that the term clinical psychologist in Medicare does not mean that your degree must specifically be in clinical psychology. What matters is that you have the appropriate clinical training and are licensed to provide direct services independently.

Many counseling psychologists, health psychologists and school psychologists are Medicare providers under the clinical psychologist designation.

Application forms

Clinical Psychologists (Specialty Code 68) should complete section 2I1 of the Medicare Enrollment Application—Physicians and Non-Physician Practitioners (CMS-855I) and all applicable sections.

Independently Practicing Psychologists (Specialty Code 62) should complete section 2I2 of the Physicians and Non-Physician Practitioners (CMS-855I) application and other applicable sections.

Electronic and paper versions of the forms are on the PECOS websiteopens in new window.

Additionally, these forms are routinely submitted in conjunction with an enrollment application:

Refer to the CMS publication, Medicare Provider Enrollment (MLN9658742)opens in new window, for additional information and resources regarding the Medicare enrollment process.

 

Keeping your enrollment current

 

Report changes within 30 days

You must update Medicare when these occur:

  • New business address
  • Change in practice ownership
  • Any final adverse actions

Examples of final adverse actions include, but are not limited to, suspension or revocation of a license, exclusion from participation in a federal or state health care program, or conviction of a felony offense.1

142 CFR §424.502

 

Report other changes within 90 days

Update any other enrollment information changes within 90 days.

 

How to report changes

 

Revalidation every five years

Psychologists in Medicare must revalidate their applications for billing privileges every five years. Using PECOS online allows psychologists to update only the sections of the enrollment application that have changes without having to redo the entire application.

Medicare will notify psychologists when it’s time to revalidate, after which psychologists have 60 days to submit the revalidated application. One 60-day extension may be requested if necessary. Failure to revalidate or respond to the revalidation notice could result in deactivation of the psychologist’s billing privileges.

In addition to processing new Medicare applications, including tracking the status of a submitted application, PECOS can also be used by existing Medicare providers to update enrollment information, complete the revalidation process, and withdraw from the Medicare program.

Date created: August 2026