Medicare will not pay for the services you provide to a Medicare beneficiary unless you have a provider number. To become a Medicare provider, you must request an application form directly from your Medicare carrier. Your local carrier will review your application and, assuming everything is in order, the carrier will issue you a provider number. In most cases the process takes about 6 weeks. Any errors or incomplete information on the application will cause delays.

Psychologists must apply to become Medicare providers. Until you have received a provider number from your local Medicare carrier, your services will not be considered "qualified" and/or "covered" services by Medicare. In other words, while your training and experience might otherwise meet the qualifications to become a Medicare provider, unless you have actually applied for and received a Medicare provider number, your services will not be paid by Medicare.¹

Consultation Requirement
Psychologists who choose to become Medicare providers are required by statute to sign an attestation agreement whereby they agree to "consult with a patient's attending physician." The psychologist's signature on the attestation agreement of the Medicare provider/supplier enrollment form indicates his/her understanding of this requirement. The purpose of consulting with the primary care physician is to consider any conditions that may be contributing to the beneficiary's symptoms. On April 23, 1998, HCFA published its final rule on clinical psychologists services.² In this final rule HCFA requires that, if the beneficiary consents to a psychologist consultation with his or her primary care or attending physician, the psychologist must attempt to consult the physician within a reasonable time after receiving the beneficiary's consent to the consultation. If attempts to consult directly (preferably by phone) with the physician are not successful, the psychologist must notify the physician, within a reasonable time, that he or she is furnishing services to the beneficiary. HCFA states that this type of effort represents a sincere attempt on behalf of the practitioner to comply with the consultation requirement regardless of whether the physician responds to the request. If the beneficiary's primary care or attending physician referred the beneficiary to the psychologist, then the consultation requirement is not necessary because the referral demonstrates consultation has occurred. However, if the beneficiary was not referred by the primary care or attending physician, then the practitioner must document in the beneficiary's medical record the date the beneficiary consented or declined consent to consultation, the date of consultation, or if attempts to consult did not succeed, the date and manner of notification to the physician. In the event that a beneficiary opts against informing the physician, psychologists should document that the patient was informed of the desirability of conferring or notifying the physician and that the patient is refusing to allow such a notification. Clear documentation of both points--the patient was informed and the patient refuses--is necessary.

Contacting Your Local Medicare Carrier
Because local Medicare Carriers and their numbers tend to change frequently, HCFA's website is your best source for accurate, up-to-date information. That website is: http://www.hcfa.gov/medicare/incardir.htm. Please call the carrier in your state to verify its procedure for obtaining a Medicare provider number.

The HCFA headquarters staff is responsible for national program direction. The regional office staff provides HCFA with the local presence necessary for quality customer service and carrier oversight. Each state is assigned to one of ten HCFA regions listed below.

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