Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers have one of the most complex Medicare enrollment processes. Before you can bill Medicare for DME, you need accreditation, a surety bond, and a physical location that passes CMS inspection — plus the enrollment itself.
This guide covers the full DMEPOS enrollment pathway and the billing basics for enrolled suppliers.
What qualifies as DMEPOS
Durable Medical Equipment (DME): Equipment that can withstand repeated use, primarily serves a medical purpose, generally not useful in the absence of illness/injury, and appropriate for use in the home. Examples:
- Power and manual wheelchairs, scooters
- Hospital beds, pressure reduction mattresses
- CPAP, BIPAP, oxygen equipment
- Nebulizers
- Blood glucose monitors and supplies
- Walkers, canes, crutches
Prosthetics: Artificial limbs (above-knee, below-knee, upper extremity)
Orthotics: Rigid or semi-rigid devices for supporting or correcting the function of a limb (AFOs, KAFOs, spinal orthoses, knee orthoses)
Supplies: Surgical dressings, ostomy supplies, urological supplies, diabetic supplies, parenteral/enteral nutrition
DMEPOS enrollment prerequisites (in order)
1. Obtain accreditation first (unless exempt) 2. Obtain surety bond 3. Establish physical location 4. File CMS-855S with NSC
Do not skip steps — accreditation and surety bond must be in place before the enrollment application is submitted.
Key applications for DMEPOS suppliers
| Form | Purpose |
|---|---|
| CMS-855S | DMEPOS supplier enrollment (filed with NSC) |
| CMS-588 | EFT setup |
Note: DMEPOS enrollment is processed by the National Supplier Clearinghouse (NSC), not your local MAC.
Step-by-step: DMEPOS enrollment
Step 1: Determine if you need accreditation
Most DMEPOS suppliers require accreditation. Exemptions:
- Physicians and NPPs supplying DMEPOS incidental to professional services to their own patients
- PTs and OTs supplying therapeutic devices only to their own patients
- Licensed pharmacies meeting CMS criteria
- State-licensed prosthetists/orthotists (state-specific)
If you’re not exempt: begin accreditation 3–6 months before you plan to submit your enrollment application.
Approved accrediting organizations:
- ACHC (Accreditation Commission for Health Care)
- CHAP (Community Health Accreditation Partner)
- The Joint Commission
- HQAA (Healthcare Quality Association on Accreditation)
- BOC (Board of Certification/Accreditation)
- NABP (for pharmacy-based DME)
Step 2: Obtain your surety bond $50,000 minimum surety bond per NPI. Must be from a CMS-approved surety company, in CMS’s required format, naming CMS as obligee.
Step 3: Set up your physical location A physical facility that:
- Is accessible during business hours
- Has signage identifying you as a DMEPOS supplier
- Has space for equipment storage and fitting/dispensing
- Meets the 30 supplier standards
Step 4: Register your Type 2 NPI With the appropriate DMEPOS taxonomy. Type 2 NPI guide →
Step 5: Complete the CMS-855S (paper) The CMS-855S is a paper application submitted to NSC (not PECOS). Full CMS-855S guide →
Step 6: Submit to NSC with supporting documentation
- Accreditation certificate
- Surety bond
- State business license
- IRS EIN documentation
- Voided check for EFT
Step 7: Site inspection NSC will conduct a site visit to verify your physical location meets requirements.
The 30 DMEPOS supplier standards
CMS codified 30 supplier standards in 42 CFR 424.57 that all DMEPOS suppliers must meet. These cover:
- Must be in compliance with all applicable federal, state, and local laws
- Must maintain a physical facility on an appropriate site
- Must have a minimum of 30 hours per week of operation
- Must permit Medicare beneficiaries to examine supplier’s items before purchase
- Must maintain information about beneficiaries in a confidential manner
- Must disclose to patients what is covered and what they’ll owe
- Must maintain and replace or repair equipment
- Must maintain liability insurance
- Must honor all warranties
- Must not pay for a referral (kickback prohibition) …and 20 more standards covering delivery, documentation, complaint resolution, and business practices
Your accreditor will verify compliance with these standards. Maintain documentation of your compliance.
DMEPOS billing basics
Billing jurisdiction: DMEPOS claims are processed by the DME MAC for your region (four jurisdictions: A, B, C, D). This is different from your physician MAC.
Competitive bidding areas (CBAs): In certain metropolitan areas designated as competitive bidding areas, Medicare only covers DMEPOS from contracted suppliers for certain product categories. If your service area is a CBA, you need to win a competitive bidding contract to supply covered items in that area. This is separate from basic enrollment.
Documentation requirements: Every DMEPOS claim requires:
- A written order/prescription from the patient’s treating physician or NPP
- The ordering provider must be enrolled in Medicare (CMS-855I or CMS-855O)
- A Certificate of Medical Necessity (CMN) for certain high-value items (power wheelchairs, hospital beds, etc.)
- Detailed Written Order (DWO) for other items
HCPCS codes: DME is billed using HCPCS Level II codes (A codes, E codes, K codes, L codes for prosthetics/orthotics).
⚠️ Risk flags
⚠️ Accreditation lapse = immediate suspension. If your accreditation lapses, NSC suspends your Medicare billing privileges without prior notice. Track accreditation expiration dates; start renewal 90 days before expiration.
⚠️ Competitive bidding areas. Operating in a CBA without a contract means Medicare won’t pay for covered CBA items regardless of your enrollment status. Verify whether your area is a CBA and which categories require contracts.
⚠️ Ordering provider enrollment. You cannot bill Medicare for items ordered by a non-enrolled physician or NPP. Verify ordering provider enrollment before processing any Medicare DMEPOS order.
⚠️ Kickback and fraud exposure. DME has historically been a high-fraud area. Paying for referrals, waiving copayments routinely, providing unnecessary equipment, or billing for items not delivered are significant compliance risks with serious consequences.
Resources
- CMS-855S — Full DMEPOS Enrollment Guide
- MCO Enrollment for DME Suppliers
- Free Medicare Enrollment Audit
DME Medicare enrollment questions? Ask Mae → Free Metolius Health enrollment audit →