42 CFR 424.515
Missed your Medicare revalidation? What deactivation actually costs
CMS can place a hold on your reimbursement or deactivate your billing privileges — and says it will not reimburse for services furnished during the deactivated period.
The obligation
Under 42 CFR 424.515, providers and suppliers other than DMEPOS suppliers must resubmit and recertify the accuracy of their Medicare enrollment information every five years, and must respond to a CMS revalidation notice with a complete application within 60 calendar days of notification. DMEPOS suppliers revalidate every three years, and CMS reserves the right to request off-cycle revalidations.
Source: 42 CFR 424.515 — revalidation of enrollment information · CMS — Revalidations
The consequence, in CMS’s own words
CMS states that failing to revalidate on time "could result in a hold on your Medicare reimbursement or deactivation of your Medicare billing privileges", and that Medicare "won’t reimburse you for any services during the period that you were deactivated".
That last clause is the one that costs real money. It is not a delay in payment; it is an absence of it for the whole deactivated period.
Reactivating requires a complete new enrollment application. And CMS is explicit that there are no exemptions from revalidation and that it does not grant extensions.
Source: CMS — Revalidations
How practices actually miss it
CMS posts revalidation due dates about seven months in advance and the MAC sends a notice by email or post roughly three to four months before the date — to the address on the Medicare enrollment record. Which, as the NPI guide on this site explains, is not updated when you update NPPES.
CMS also says the provider is responsible for tracking their own due date. Revalidate if you are within three months of it even without a notice; do not submit if the date is more than seven months away, because unsolicited revalidations are returned.
Source: CMS — Revalidations · CMS NPI Fact Sheet (PDF)
Find your own date in about ten seconds
CMS publishes every assigned due date as a free open dataset. We indexed it, so you can type your NPI into the lookup on this site and read yours without an email address or a signup.
Questions
How often is Medicare revalidation required?
Generally every five years under 42 CFR 424.515, and every three years for DMEPOS suppliers. CMS can also request an off-cycle revalidation at its discretion.
How long do I have to respond to a revalidation notice?
42 CFR 424.515 requires a complete application within 60 calendar days of notification.
Can I get an extension?
No. CMS states there are no exemptions from revalidation and that it does not grant extensions.
How do I find my due date?
CMS publishes the Revalidation Due Date List as a free public dataset and posts dates about seven months in advance. The free lookup on this site searches it by NPI, with no email required.
A research summary, not legal or enrollment advice. Every rule above links to the regulation or the CMS document it came from so you can check it rather than trust it.
The rest of the cluster
If this is work somebody on your team is doing at four in the afternoon, it can be a seat.
Next step
A lapsed enrollment stops every claim behind it
A credentialing seat works enrollments, revalidations and CAQH attestation, so none of these dates arrives unannounced.
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