What the check reads
- Order and Referring file
- 2,058,178
- NPIs, as of October 8, 2026
- Revalidation Due Date List
- 2,961,402
- enrollments for 2,460,002 NPIs, October 1, 2026
- Opt-out affidavits
- 57,763
- 56,998 NPIs, updated through September 15, 2026
- Pending initial applications
- 12,195
- 4,638 physician, 7,557 non-physician, October 8, 2026
- NPIs in both main files
- 1,752,642
- Order and Referring and the revalidation list
- Revalidation dates assigned
- 9.5%
- 282,007 enrollments; the rest read TBD
The two large files answer different questions. The Order and Referring file lists individual physicians and practitioners who may order, refer or certify services for Medicare patients; the Revalidation Due Date List lists enrollments that bill Medicare, one row per enrollment, so a practitioner enrolled in two states appears twice. 305,536 NPIs are in the Order and Referring file with no enrollment on the revalidation list, and 707,360 NPIs are on the revalidation list but not in the Order and Referring file; 435,731 of the latter hold an organization enrollment, and the most common enrollment specialties among them are Clinic/Group Practice (262,040), Physical Therapist In Private Practice (113,082), Certified Registered Nurse Anesthetist (CRNA) (46,306) and Chiropractic (44,978). A missing entry in one file is therefore not an error by itself: read the result for the question the claim asks.
How Medicare uses the Order and Referring file
To order or certify for a Medicare patient, a practitioner needs an individual NPI, an enrollment in an approved or an opt-out status, and an eligible specialty: doctors of medicine and osteopathy, dentists, podiatrists, optometrists (with limitations), physician assistants, clinical nurse specialists, nurse practitioners, clinical psychologists, interns, residents and fellows, certified nurse midwives, clinical social workers, marriage and family therapists and mental health counselors. Practitioners who do not bill Medicare can enroll for this purpose alone on form CMS-855O. Organizational NPIs cannot order or certify (CMS ordering and certifying requirements).
Medicare contractors switched on the denial edits on January 6, 2014 (change request 8356): claims from clinical laboratories for ordered tests, from imaging suppliers for ordered imaging, from DMEPOS suppliers for ordered items and from home health agencies are checked against the file. Denials for power mobility devices ordered by a practitioner of a type not authorized to order them followed on April 7, 2014. Since June 3, 2024, hospices are paid only when the certifying physicians, including the hospice attending physician, are enrolled or opted out; contractors apply that edit to the attending and referring NPI fields on hospice claims submitted from October 7, 2024 (MLN Matters MM13531).
Change request 8356 fixes the codes contractors return when the ordering or referring practitioner fails the edit on a Part B clinical lab or imaging claim or a DMEPOS claim. The CARC and RARC tell you whether the problem is eligibility, the name or a missing NPI, and so whether a corrected claim or an enrollment fix is needed.
| Why the line fails | Group, CARC and RARCs | What fixes it |
|---|---|---|
| The ordering or referring practitioner is not eligible (not in the file for that category) | CO-183 with N574 and MA13 | An approved enrollment or opt-out for an eligible practitioner type, or the correct ordering NPI |
| The first four letters of the last name on the claim do not match the enrollment record | CO-16 with N264, N575 and MA13 | A corrected claim with the name as enrolled |
| An ordering or referring practitioner is named but the NPI is missing (claim rejected, not denied) | CO-16 with N265 and MA13 | Resubmit with the practitioner's individual NPI |
Which practitioners carry which flags
Across the file, 95.4% of NPIs carry Y for Part B, 99.2% for DME, 82.7% for home health, 78.8% for power mobility devices and 55.7% for hospice. The table matches each NPI to the specialty of its individual Part B enrollment on the revalidation list (or its opt-out affidavit) to show how the flags follow the practitioner type. Nurse practitioners (99.7% home health, 100% PMD) and physician assistants (99.8% and 100%) carry nearly every flag but never the hospice one: hospice certification needs a physician. The behavioral health professions (clinical social workers, mental health counselors, marriage and family therapists and clinical psychologists) carry Part B and DME; at most 0.1% of them carry home health, PMD or hospice. Optometrists and podiatrists carry every flag except PMD (0.2% and 0.8%): CMS lets only authorized specialties order power mobility devices, and this column is where the file records it. Physician specialties such as internal medicine carry all five (99.8% for hospice).
| Specialty | NPIs | Part B | DME | HHA | PMD | Hospice |
|---|---|---|---|---|---|---|
| Nurse Practitioner | 365,956 | 99.7% | 100% | 99.7% | 100% | 0% |
| Physician Assistant | 173,271 | 99.8% | 100% | 99.8% | 100% | 0% |
| Internal Medicine | 123,709 | 99.8% | 100% | 99.8% | 100% | 99.8% |
| Family Practice | 117,109 | 99.8% | 100% | 99.8% | 100% | 99.8% |
| Clinical Social Worker | 101,314 | 99.1% | 100% | 0% | 0% | 0% |
| Mental Health Counselor | 71,928 | 99.2% | 100% | 0% | 0% | 0% |
| Emergency Medicine | 62,919 | 99.9% | 100% | 99.9% | 100% | 99.9% |
| Pediatric Medicine | 55,111 | 99.9% | 100% | 99.9% | 100% | 99.9% |
| Anesthesiology | 50,045 | 99.7% | 100% | 99.7% | 100% | 99.7% |
| Optometry | 46,126 | 99.8% | 100% | 99.8% | 0.2% | 99.8% |
| Obstetrics/Gynecology | 42,725 | 99.8% | 100% | 99.8% | 100% | 99.8% |
| Psychiatry | 40,703 | 99.5% | 100% | 99.5% | 100% | 99.5% |
| Clinical Psychologist | 40,269 | 99.4% | 100% | 0.1% | 0.1% | 0.1% |
| Diagnostic Radiology | 37,401 | 99.8% | 100% | 99.8% | 100% | 99.8% |
| General Surgery | 27,186 | 99.8% | 100% | 99.8% | 100% | 99.8% |
| Orthopedic Surgery | 26,664 | 99.8% | 100% | 99.8% | 100% | 99.8% |
| Hospitalist | 25,515 | 99.9% | 100% | 99.9% | 69.4% | 99.9% |
| Cardiovascular Disease (Cardiology) | 23,303 | 99.9% | 100% | 99.9% | 100% | 99.9% |
| Neurology | 21,184 | 99.8% | 100% | 99.8% | 100% | 99.8% |
| Ophthalmology | 20,656 | 99.9% | 100% | 99.9% | 100% | 99.9% |
| Gastroenterology | 17,668 | 99.9% | 100% | 99.9% | 100% | 99.9% |
| Podiatry | 17,619 | 99.8% | 100% | 99.8% | 0.8% | 99.8% |
| Marriage And Family Therapist | 17,145 | 99.2% | 100% | 0% | 0% | 0% |
| Certified Registered Nurse Anesthetist (CRNA) | 16,080 | 99.4% | 0.7% | 0.6% | 0.7% | 0.1% |
Revalidation due dates and what "not yet assigned" means
Medicare re-checks every enrollment on a cycle: providers and suppliers generally revalidate every five years and DMEPOS suppliers every three. CMS posts each due date about seven months ahead on its revalidation page (the data.cms.gov description says six months), and the Medicare contractor mails or emails a revalidation notice about three to four months before it. Until a date is posted, the list shows TBD, which this check reports as "not yet assigned". Late revalidation can put Medicare payments on hold or deactivate billing privileges; reactivating takes a complete new application, and services furnished while deactivated are not paid.
In the October 1, 2026 release, 282,007 of 2,961,402 enrollments carry a date. 44,592 fall in October 2026 through March 2027, and 237,415 are earlier than the release date, going back to July 31, 2023. The list does not say whether those earlier revalidations were received, so the check shows the date as published and points to PECOS or the contractor for the current status. DMEPOS supplier enrollments, on the three-year cycle, are the most likely to carry a date: 83.5% of 69,844, against 7.2% of Part B enrollments and 30.4% of Part A enrollments.
| Month due | Enrollments | Count |
|---|---|---|
| October 2026 | 6,607 | |
| November 2026 | 8,001 | |
| December 2026 | 6,729 | |
| January 2027 | 7,847 | |
| February 2027 | 7,783 | |
| March 2027 | 7,625 |
| Enrollment type | Enrollments | NPIs | With a due date |
|---|---|---|---|
| Non-DME Part B | 2,820,183 | 2,381,860 | 201,955 (7.2%) |
| Part A | 71,375 | 69,039 | 21,699 (30.4%) |
| DME | 69,844 | 69,837 | 58,353 (83.5%) |
Opt-out status and dates
Doctors of medicine, osteopathy, dental surgery or dental medicine, podiatric medicine and optometry, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, certified nurse midwives, clinical psychologists, clinical social workers, registered dietitians and nutrition professionals, marriage and family therapists and mental health counselors may opt out of Medicare by affidavit. The opt-out lasts two years and renews automatically unless the practitioner cancels in writing at least 30 days before the period ends; an initial opt-out can be terminated within its first 90 days (CMS enrollment management). Medicare pays neither the practitioner nor the patient for services under the private contract.
The opt-out file updated through September 15, 2026 holds 57,763 affidavits for 56,998 NPIs; 56,824 were in effect on that date, 241 take effect later and 698 have an end date that has passed. 30,296 affidavits (52.4%) are flagged eligible to order and refer, so labs, imaging suppliers and DMEPOS suppliers can bill Medicare for those practitioners' orders. Who opts out, by specialty, state and year, is in the Medicare opt-out providers report.
Pending initial applications
CMS also publishes the initial physician and non-physician enrollment applications that are waiting for contractor review, so a practitioner can confirm that an application arrived. The October 8, 2026 lists hold 4,638 physician and 7,557 non-physician NPIs. A pending application is not an approval: until the contractor approves it, the NPI does not pass the ordering and referring edit and cannot bill. 1,070 of the pending NPIs are already in the Order and Referring file, so for them the ordering and referring edit already passes while the new application waits.
What the check does not tell you
- It shows CMS's files as of the dates above, not the live PECOS record. A change made since then, such as a new approval, a deactivation or an opt-out cancellation, appears after the next refresh.
- It covers Original Medicare enrollment only. Medicare Advantage plans, Medicaid programs and commercial payers keep their own provider enrollment and credentialing records.
- It is not the NPI registry. Names, addresses and taxonomies come from NPPES; this check deliberately shows no names or addresses, and CMS leaves deceased practitioners out of the Order and Referring file.
- It does not show reassignments, practice locations or the billing relationship between a practitioner and a group.
- 157 rows across the files carry an NPI that fails the NPPES check digit; they are left out, and the check rejects such numbers as typing errors.
Related references: the PECOS glossary entry, what an NPI is, the Medicare prior authorization list for orders that also need prior authorization, and the DMEPOS fee schedule for the items a DMEPOS order covers.
Where QuickIntell fits with provider enrollment
The check answers one NPI at a time from CMS's monthly files. QuickIntell's credentialing software organizes provider profiles, payer applications, enrollment status and renewal tracking with review controls, which is where a practitioner's Medicare enrollment, revalidation date and opt-out status belong before claims go out.
Frequently asked questions
Is this the PECOS lookup?
It reads the public files CMS builds from PECOS, the Provider Enrollment, Chain, and Ownership System: the Order and Referring file (October 8, 2026), the Revalidation Due Date List (October 1, 2026), the opt-out affidavit file and the pending initial application lists. It is not the PECOS login. Enrollment applications, revalidations, changes and opt-out cancellations are filed in PECOS itself or with the Medicare Administrative Contractor.
How do I check whether a provider can order or refer for Medicare?
Enter the practitioner's individual NPI. If it is in the Order and Referring file, the check shows Y or N for each of the five columns CMS publishes: PARTB (clinical laboratory and imaging), DME, HHA, PMD and HOSPICE. The October 8, 2026 file lists 2,058,178 NPIs; 1,003,508 of them carry Y in all five columns.
What does TBD or not yet assigned mean for a revalidation due date?
CMS's description of the Revalidation Due Date List says a due date that does not fall within the next six months is marked TBD (a blank date in the download), so not yet assigned means the next revalidation is further out. In the October 1, 2026 release, 2,679,395 of 2,961,402 enrollments (90.5%) have no date yet. Once a date is posted, the Medicare contractor sends a revalidation notice about three to four months before it.
How often do Medicare providers revalidate?
Most providers and suppliers revalidate every five years; DMEPOS suppliers revalidate every three years. Missing the due date can put Medicare payments on hold or deactivate billing privileges, and Medicare does not pay for services furnished while billing privileges are deactivated.
Can an opted-out physician still order tests or equipment for Medicare patients?
Yes, if the practitioner is of an eligible type: CMS lets practitioners in an approved or an opt-out status order and certify. The opt-out file flags it per affidavit: 30,296 of 57,763 records say eligible to order and refer, and 33,404 opted-out NPIs also appear in the Order and Referring file.
Why is an NPI not found?
The NPI may belong to a practitioner who enrolled after the file dates shown, who has never enrolled in Medicare or whose enrollment has ended. A typing error is the other common cause, which is why the check rejects numbers that fail the NPI check digit before looking them up; a valid NPI that is still not found can be confirmed in the NPI registry (NPPES) and then in PECOS.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.
- Medicare Order and Referring file, October 8, 2026Version data.cms.gov release 2026-10-08 · effective 2026-10-08 · file OrderReferring_20261008.csvSHA-256 4f3ebcda22291348…
- Medicare Revalidation Due Date List, October 1, 2026Version data.cms.gov release 2026-10-01 · effective 2026-10-01 · file revalidation_base.csvSHA-256 e30812ba12d0c67c…
- Medicare Opt-Out Affidavits, August 2026 fileVersion August 2026 (data.cms.gov) · effective 2026-09-15 · file OptOut_August2026.csvSHA-256 16508f104a3b8040…
- Pending Initial Logging and Tracking, physicians, October 8, 2026Version data.cms.gov release 2026-10-08 · effective 2026-10-08 · file PendingInitialLandTsPhysicians_20261008.csvSHA-256 5bf7d521b9b367b6…
- Pending Initial Logging and Tracking, non-physicians, October 8, 2026Version data.cms.gov release 2026-10-08 · effective 2026-10-08 · file PendingInitialLandTsNonPhysicians_20261008.csvSHA-256 57229efa5436133b…
Disclaimer
Operational lookup built from CMS public files. Each answer reflects the file dates shown and may lag PECOS; confirm enrollment, revalidation and opt-out status in PECOS or with the Medicare Administrative Contractor before relying on it for a claim. Lookups are not stored. Not legal or billing advice.
Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.