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Checking Medicare Eligibility

This revised product comprises Subregulatory Guidance for checking Medicare eligibility and its content is based on publicly available content within:
- https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS050111
- https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS012673
- https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912
CMS policy or operation subject matter experts also reviewed/cleared this product.
This product informs health care professionals and administrative staff about checking Medicare eligibility. It’s useful for physicians, non-physician practitioners, health care administrators, medical coders, billing and claim processing personnel, and other medical administrative staff responsible for submitting claims for payment.
No substantive content updates were made to this product.

Download the Guidance Document

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: September 17, 2020

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.