Medicare - PECOS
The Affordable Care Act requires physicians and other eligible Non-Physician Practitioners (NPPs) to be registered in the PECOS database to order/refer services for Medicare patients.
Below are PECOS-related FAQs that were developed to assist you with the PECOS registration process. Please contact your local Medicare Contractor for specific and comprehensive information regarding PECOS, the enrollment process, and choosing to opt-out.
Medicare Enrollment FAQs
The Centers for Medicare & Medicaid Services (CMS) has created a way for providers to register in Medicare online. The system for enrolling online is called the Internet-based Provider Enrollment, Chain and Ownership System (PECOS).
If you order laboratory or other ancillary services for Medicare patients, such as laboratory testing from Genova Diagnostics you must:
- be registered in PECOS with a status of either enrolled or opted out
- be listed in Medicare's ordering and referring files (data.cms.gov/Medicare-Enrollment/Order-and-Referring/qcn7-gc3g)
- If you wish to order or refer for ancillary services for Medicare Beneficiaries such as lab tests, x-rays, consultations, or DME, you must be registered in PECOS.
- If you want to order or refer these types of services for Medicare patients without enrolling in Medicare, you must Register for the Sole Purpose of Ordering and Referring.
- If you do not order or refer these types of services for Medicare patients.
Please Note: Because reimbursement for doctors of chiropractic is limited to spinal manipulation under Medicare, doctors of chiropractic medicine cannot order or refer ancillary services.
Yes. If you want to order and refer services for Medicare patients, you must have a registered status of either Enrolled or Opted Out via PECOS. You must opt out even if you do not bill Medicare for services you perform for your Medicare patients.
The best way to opt out is to use online PECOS and submit your application with the option to Register for the Sole Purpose of Ordering and Referring. You may also submit an Opt-Out affidavit to Medicare (this option usually takes much longer for Medicare to process).
You can find more details about registering here: PDF – Medicare Enrollment Guidelines for Ordering/Referring Providers
You may also check the following sources:
- Ordering And Referring Report at www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/MedicareOrderingandReferring.html.
- Your Local Medicare MAC Contractor. Please see www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/downloads/contact_list.pdf to determine your contractor's contact information.
Unless your registration application has been received by Medicare within 30 days of an order submitted for a Medicare patient, the claim will be denied and may be billed to your professional account.
As a result, if you are not registered in PECOS, your professional account could be billed for laboratory services that you order and refer.
Medicare does not hold the patient liable for claim denials due to the referring provider's PECOS registration.
- If you order or refer services that are eligible for coverage for Medicare beneficiaries, registering in PECOS will help ensure those claims won't be denied and possibly billed to your professional account.
- CMS believes that the PECOS system is more efficient than using a paper based system, particularly because Medicare contractors are able to process Internet-based PECOS applications within 30 to 45 calendar days, compared to 60 to 90 calendar days under the paper based system.
If you choose to not order or refer Medicare patients for any services, you do not need to register. However, if you have requested laboratory services for a Medicare patient your professional client account could be billed for those services automatically if you choose not to register.
To avoid this from happening, we suggest that you register in PECOS as an opted out provider.