OMB control number

Medicare Enrollment Application: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers (Form 855S)

OMB 0938-1056 · HHS/CMS.

OMB 0938-1056

The primary function of the CMS 855S Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) supplier enrollment application is to gather information from a supplier that tells us who it is, whether it meets certain qualifications to be a health care supplier, where it renders its services or supplies, the identity of the owners of the enrolling entity, and information necessary to establish correct claims payment. The goal of this revision of the CMS 855S is to simplify and clarify the current data collection and to remove obsolete and/or redundant questions. Grammar and spelling errors were corrected. Limited informational text has been added within the application form and instructions in conjunction with links to websites when greater detail is needed by the supplier. To clarify current data collection differentiations and to be in sync with accreditation coding, Section 3D (“Products and Services Furnished by This Supplier”) has been updated. This revision does not offer any new material data collection.

The latest form for Medicare Enrollment Application: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers (Form 855S) expires 2026-04-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-855S Reactivation - Medicare Enrollment Application Form and Instruction
Form CM-855S Voluntary Withdrawing from Medicare Form and Instruction
Form CMS-855S Revalidation of enrollment information Form and Instruction
Form CMS-855S Change of Enrollment Information Form and Instruction
Form CMS-855S Initial Enrollment Form and Instruction
CMS-855S.Response to 60-day public comments.docx Supplementary Document
CMS-855S - Supporting Statement.docx Supporting Statement A
Reactivation - Medicare Enrollment Application Form and Instruction
Voluntary Withdrawing from Medicare Form and Instruction
Revalidation of enrollment information Form and Instruction
Change of Enrollment Information Form and Instruction
Initial Enrollment Form and Instruction

All Historical Document Collections

202511-0938-011	Revision of a currently approved collection	2025-11-21
202309-0938-006 Approved without change	Revision of a currently approved collection	2023-09-20
202201-0938-015 Approved without change	No material or nonsubstantive change to a currently approved collection	2022-01-11
202001-0938-004	Reinstatement without change of a previously approved collection	2020-09-14
201611-0938-010 Approved with change	Revision of a currently approved collection	2016-11-18
201610-0938-004 Comment filed on proposed rule and continue	Revision of a currently approved collection	2016-10-20
201512-0938-004 Approved with change	Revision of a currently approved collection	2015-12-22
201210-0938-010 Approved with change	Revision of a currently approved collection	2012-10-31
201105-0938-016 Approved with change	Revision of a currently approved collection	2011-05-31
200810-0938-001 Approved with change	New collection (Request for a new OMB Control Number)	2008-10-01

OMB Details

Initial Enrollment

Federal Enterprise Architecture: Health - Health Care Services

Form CMS-855-S	Medicare Enrollment Application: Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers	Fillable Fileable	Form and instruction
Form CMS-855S	Medicare Durable Medical Equipment Supplier Enrollment Application	Fillable Fileable	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.