CMS Updates Institutional Provider Enrollment Application Fee for 2025

02/10/2025

CMS Updates Institutional Provider Enrollment Application Fee for 2025 

 

The Centers for Medicare & Medicaid Services (CMS) has announced an update to the institutional provider enrollment application fee for the calendar year 2025. Effective for applications submitted between Jan. 1 and Dec. 31, 2025, the new fee will be $730, reflecting an adjustment to cover administrative costs associated with provider enrollment. 

Understanding the implications of this fee update is crucial for providers participating in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Below, we break down what this means, who is affected, and how to ensure compliance. 

What Is the Enrollment Application Fee? 

The CMS enrollment application fee is a mandatory, non-refundable charge for certain institutional providers applying for participation in federal healthcare programs. The fee is intended to cover the cost of provider screening, background checks, and administrative processes required to ensure program integrity. 

Each year, CMS reviews and adjusts the fee based on inflation and other regulatory factors. For 2025, the amount has increased from previous years to $730 per application. 

Who Is Affected? 

The updated fee applies to institutional providers submitting applications for: 

  1. Initial Enrollment 
  2. Providers or suppliers seeking to join Medicare, Medicaid, or CHIP for the first time must pay the enrollment fee. 
  3. Revalidation of Enrollment 
  4. CMS requires providers and suppliers to periodically revalidate their enrollment information to ensure accuracy and prevent fraud. If your practice is due for revalidation in 2025, you must submit the updated fee along with your application. 
  5. Adding a New Medicare Practice Location 
  6. If an existing Medicare-enrolled institutional provider expands operations and adds a new practice location, a separate enrollment fee is required. 

Exemptions and Waivers 

Certain provider types and transactions are exempt from the enrollment fee. These include: 

  • Individual practitioners (e.g., physicians, nurse practitioners, therapists) who are enrolling in Medicare, Medicaid, or CHIP. 
  • Organizations that qualify as non-profit or government-owned entities may be eligible for a hardship waiver. 
  • Providers enrolling solely to order, certify, or prescribe services may not be required to pay the fee. 

To request an application fee waiver, providers must submit supporting documentation and meet CMS’s hardship criteria. 

Why Is the Fee Increasing? 

The fee adjustment reflects inflationary factors and administrative costs associated with maintaining program integrity. CMS conducts rigorous screening processes for institutional providers, including: 

  • Verification of credentials and licenses 
  • Screening for fraud, waste, and abuse 
  • Site visits and compliance checks 

The $730 application fee helps offset these costs while ensuring that only qualified and compliant providers participate in federal healthcare programs. 

Steps to Ensure Compliance 

To avoid processing delays or application denials, providers should take the following steps: 

  • Verify Enrollment Deadlines: Check your Medicare, Medicaid, or CHIP enrollment status and confirm whether you need to submit an initial enrollment, revalidation, or location update in 2025. 
  • Budget for the New Fee: Ensure your organization accounts for the updated $730 fee when planning administrative expenses for the upcoming year. 
  • Use PECOS for Faster Processing: The Provider Enrollment, Chain, and Ownership System (PECOS) allows for online submissions and expedited processing. CMS recommends using PECOS whenever possible. 
  • Check for Waiver Eligibility: If you believe your institution qualifies for an exemption or hardship waiver, gather the necessary documents and apply in advance to avoid delays. 
  • Monitor CMS Updates: CMS policies can change throughout the year. Stay informed by checking official CMS provider enrollment bulletins and updates from your Medicare Administrative Contractor (MAC). 


Read more articles