Updated 2026-07-30
The CMS Order & Referring file lists practitioners eligible to order or refer for Medicare patients across five program contexts: Part B services, DME, Home Health, Power Mobility Devices, and Hospice. Claims that depend on an order or referral need the ordering practitioner listed in the right context. PECOS Lookup shows whether an NPI appears in the loaded file and, when it does, the exact per-program flags, with the file's vintage on the result.
Medicare pays many claims that originate with an order, referral, or certification — a lab test, a wheelchair, a home health episode. The CMS Order & Referring file is the public list of individual practitioners eligible to originate those services, and downstream billers check it because a claim citing an unlisted practitioner risks rejection.
The file covers individual practitioners only — eligibility to order and refer is personal, not organizational — and being listed does not establish billing privileges for the practitioner's own services.
Each flag is independent: a practitioner can be eligible in one context and not another. The lookup here mirrors the loaded file's five flags exactly — the same order/refer verbs the file uses — never a single collapsed yes/no.
Run the practitioner's 10-digit NPI through the lookup on the home page. An exact-NPI match in the loaded file shows the per-program flags with the file's vintage and check time. Medicare's own criteria decide who appears — enrolled practitioners and validly opted-out practitioners with ordering eligibility both can — and the same result shows the public enrollment signal and opt-out status alongside. See NPI vs PECOS for how registry and enrollment data differ.
An NPI not found in the loaded file is not a negative finding: CMS updates the file on its own cadence and public files lag the live system. For a claim-critical decision, verify against the current official file linked below.
No. The file covers eligibility to order, refer, and certify for others' claims. It does not establish billing privileges for the practitioner's own services, and it says nothing about payment of any claim.
The five contexts have different rules — for example, Home Health certification is limited to certain practitioner types. A practitioner can genuinely be eligible in some contexts and not others, which is why the lookup shows each flag separately.
Check any NPI's five order-and-refer program flags free — exact-NPI matches with the CMS file's vintage on every result