What Is PECOS? Medicare Provider Enrollment Explained

PECOS is the system most providers interact with only a handful of times in their careers, yet its status determines whether Medicare will pay a claim. Understanding what it is, how it connects to NPPES and the I&A system, and what it cannot do saves considerable time when something goes wrong with enrollment or when a billing team needs to verify a provider's Medicare status.

What PECOS Does

PECOS is the primary database CMS uses to store, process, and maintain Medicare enrollment records for providers and suppliers. When a provider submits a Medicare enrollment application, whether online through PECOS or on a paper CMS-855 form, the resulting record lives in PECOS. That record is what Medicare references when processing a claim: it confirms the provider is enrolled, identifies their billing arrangement, and stores their Electronic Funds Transfer information so payments can be made.^[1]

PECOS handles four main enrollment actions:

• Initial enrollment: A provider or supplier enrolls in Medicare for the first time.
• Changes to enrollment information: Updates to practice location, ownership, banking information, or other reportable details.
• Revalidation: Periodic recertification of enrollment information, required every five years for most providers and every three years for DMEPOS suppliers.
• Re-enrollment: Rejoining Medicare after a billing privilege revocation or deactivation.

The Three-System Chain: I&A, NPPES, and PECOS

One of the most frequently misunderstood aspects of Medicare enrollment is the relationship among three distinct CMS systems. Each has a separate purpose, but a single set of credentials connects them.

The Identity & Access Management (I&A) System is the shared login gateway. A single I&A account allows a provider to use all three systems. The standard sequence for a new provider is: create an I&A account, use it to apply for an NPI in NPPES, and then use the same credentials to enroll in Medicare through PECOS.^[1]

For organizational providers and suppliers, an Authorized Official (AO) must be designated through the I&A system before anyone can act in PECOS on the organization's behalf. The AO can in turn authorize Access Managers, Surrogates, and Staff End Users. Individual providers do not need an AO but can authorize Surrogates and Staff End Users.^[2]

PECOS vs. NPPES: Key Differences

The distinction between these two systems trips up providers and billing staff regularly, particularly around the question of whether updating one system updates the other. The short answer is no: they are entirely separate databases that do not sync automatically.

Who Needs to Enroll in PECOS

Any provider or supplier who wants to receive payment from Medicare for covered services must be enrolled through PECOS or an equivalent paper process. This includes physicians, non-physician practitioners, institutional providers, group practices, DMEPOS suppliers, and Medicare Diabetes Prevention Program suppliers, among others.^[1]

There is one additional category that sometimes surprises providers: those who solely order or certify items and services for Medicare patients without billing directly. Physicians and eligible professionals who write orders for power mobility devices, home health services, or other certified items must also be enrolled in PECOS in an approved or opt-out status for those orders to be payable, even if they do not submit Medicare claims themselves.^[6]

Part C (Medicare Advantage) and Part D (prescription drug plan) providers are an exception: they do not need to enroll in Medicare in an approved or opt-out status through PECOS for their Part C or Part D activities.^[6]

The Application Fee

Most individual providers pay no application fee when enrolling in Medicare through PECOS. The fee applies to institutional providers and suppliers, specifically those who submit enrollment applications on forms CMS-855A, CMS-855B (except physician and non-physician practitioner organizations), or CMS-855S. In plain terms, this means hospitals, skilled nursing facilities, DMEPOS suppliers, and opioid treatment programs, among others, pay the fee.^[3]

The 2026 enrollment application fee is $750. This fee applies when enrolling for the first time, re-enrolling, revalidating, or adding a new practice location.^[3] The fee can be paid during the PECOS application process or through the PECOS Application Fee page.

A hardship exception may exempt a provider from paying the current application fee. To request one, submit a written request and supporting documentation with the PECOS application. CMS grants exceptions on a case-by-case basis. If the fee is not paid and no hardship exception is submitted, the provider's MAC will send a 30-day notice. Failure to pay within that period may result in the application being rejected or existing billing privileges being revoked.^[3]

What PECOS Cannot Do

PECOS handles the majority of enrollment changes online, but several types of changes must be submitted using the appropriate paper CMS-855 enrollment application instead.^[2] Attempting these changes through PECOS will not work:

• Changing a Social Security Number
• Changing a provider's or supplier's Tax Identification Number (TIN)
• Changing an existing business structure (for example, converting a sole proprietorship to an LLC, or vice versa)

There are also situations that require a new enrollment application rather than a change to an existing one. A new enrollment is needed when a provider changes specialties in a way that requires new state surveys, when there is a change of ownership, when a new TIN is created because of a change of ownership, or when a location changes from provider-based to freestanding (or vice versa).^[2]

Note that DMEPOS suppliers face one additional restriction: each enrollment record can have only one current business location. Adding a new practice location for a DMEPOS supplier requires a new PECOS application rather than a change to the existing one.^[4]

Availability and Access

PECOS is available online around the clock, Monday through Saturday, with scheduled downtime on Sundays for system maintenance. CMS offers technical support every day from 5 am to 8 pm Central Time.^[2]

Using PECOS online is strongly encouraged over paper applications, but it is not mandatory. All Fee-for-Service providers can apply in PECOS. If a paper application is submitted instead, the MAC enters the data into PECOS, so a PECOS record is created regardless of how the application was filed.^[2]

How to Verify PECOS Enrollment Status

There are two ways to confirm that a provider's current Medicare enrollment record exists and is active in PECOS without logging into the system itself:^[6]

• The Order and Referring datasets at data.cms.gov list providers who are enrolled and eligible to order or certify items for Medicare patients. Being present on one of these lists confirms active enrollment status for ordering and referring purposes.
• PECOS login allows a provider to view their own enrollment record directly and see whether its status is approved.

For providers who submitted enrollment applications as ordering/certifying providers and want to check whether those applications are still pending, CMS maintains the Pending Initial Logging and Tracking datasets for both physicians and non-physicians at data.cms.gov.

PECOS Enrollment on NPI Profile

Every provider profile on NPI Profile includes a PECOS enrollment indicator derived from the publicly available Medicare Order and Referring data. When you search for a provider and see "PECOS Enrolled: Yes," it means the provider appears in the current CMS Order and Referring dataset, confirming active Medicare enrollment status. A "No" result means the provider is either not enrolled or not enrolled in a status that appears in the public dataset.

The PECOS flag on NPI Profile is updated on the same weekly cycle as the core NPI data. It reflects CMS's published Order and Referring data, not real-time PECOS system queries. For official verification of enrollment status, particularly for credentialing or claim submission purposes, use the PECOS system or the CMS Order and Referring datasets directly.