US Medicare Provider and Supplier Enrollment (42 CFR Part 424 Subpart P) 424.514: Institutional providers must pay the annual application fee (or request a hardship exception) with each initial, new-location and revalidation application, and pay within 30 days if a hardship exception is refused

What does 424.514 require?

Prospective institutional providers (those enrolling on Form CMS-855A, CMS-855B other than physician and practitioner organisations, or CMS-855S, or the PECOS equivalent) submitting an initial application or an application to add a new practice location, and institutional providers revalidating, must submit the application fee for the calendar year (the base amount indexed annually by the CPI-U, nonrefundable except where a hardship exception is approved, the application is rejected before screening or denied under a moratorium) or a written hardship exception request describing the hardship. A contractor may reject the application, or revoke the billing privileges of a revalidating provider, after notifying the provider that the fee was not submitted and allowing 30 days; where the bank account lacks funds to pay, billing privileges may be denied or revoked. CMS decides hardship requests within 60 days, does not process the application meanwhile, and allows 30 days to pay the fee after a refusal; hardship determinations are appealable.