Part I: Reason for submission
New EFT Enrollment (Individual or Group) or Change to Current EFT Enrollment, plus a box for EFT payment to a Chain Home Office with an attached authorizing letter.
CMS-588
Electronic Funds Transfer (EFT) Authorization Agreement
- Agency
- CMS
- Revision
- 11/2023
- Fillable fields
- 39
- Pages
- 4
- Official source
- CMS form page
- Checked
- October 20, 2026
Form CMS-588: Electronic Funds Transfer (EFT) Authorization Agreement
Form CMS-588 is the Electronic Funds Transfer (EFT) Authorization Agreement from the Centers for Medicare & Medicaid Services. Providers and suppliers use it to authorize CMS to deposit Medicare payments into a bank account by EFT, either as a new EFT enrollment or as a change to a current one, such as an account or bank change.
The form has five parts: reason for submission, account holder information, financial institution information, a contact person, and the authorization signed by the Authorized or Delegated Official named on the CMS-855 Medicare enrollment application. Two pages of instructions come first in the same PDF. The form notes that EFT enrollment is for EFT authorization only and does not constitute enrollment as a provider or supplier in the Medicare program.
The instructions say to upload the form to PECOS or mail it to the Medicare contractor that services your geographical area. You can fill it out free in your browser on this page and download the result without an account.
What's on Form CMS-588
Part II: Account holder information
Legal business name as reported to the IRS, chain organization or home office name and number, street address (no PO boxes), TIN with SSN or EIN, the 10-digit NPI and any Medicare identification numbers issued.
Part III: Financial institution
Bank name and street address (no PO boxes), optional phone and contact person, the 9-digit routing transit number, the account number including all zeros, and checking or savings.
Bank confirmation
The instructions ask for a confirmation of account information on bank letterhead, with the bank officer's name and signature, or a voided check, in the legal business name. The form says starter checks are not acceptable.
Part IV: Contact person
Name, title, telephone number and email of the person to contact with questions about this EFT.
Part V: Authorization
The EFT authorization text and a signature line for the Authorized or Delegated Official: printed name, phone, optional email, signature and date. The form notes it has to be signed and dated to process.
Two pages of instructions, then the two-page agreement.
How to fill out Form CMS-588
- 1
Choose the reason
Check New EFT Enrollment (Individual or Group) or Change to Current EFT Enrollment. For payment to a Chain Home Office, check that box and attach the authorizing letter.
- 2
Enter account holder details
Use the legal business name and TIN as reported to the IRS, and enter the 10-digit NPI, which the instructions say is required to process the form.
- 3
Enter bank details and attach proof
Enter the bank, routing number and account number, choose the account type, and attach bank letterhead or a voided check in the legal business name.
- 4
Name a contact person
Enter the name, title, phone and email of someone who can answer questions about the form.
- 5
Sign Part V
The instructions say the same Authorized Representative or Delegated Official named on the CMS-855 enrollment application on file signs and dates it, with a phone number.
- 6
Upload or mail it
Upload the form to PECOS or mail it to the Medicare contractor that services your area, one for each Medicare contractor you submit claims to.
Why fill Form CMS-588 on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- The official blank straight from the CMS, not a copy someone retyped
- Works on a phone, tablet or computer
Where it goes and what to know
Where to send it
Upload it to PECOS or mail it to the Medicare contractor that services your geographical area. The instructions point to a CMS contact list for contractor mailing addresses. The form says not to mail it to the CMS PRA Reports Clearance Officer, which will significantly delay processing.
One per contractor
The instructions say an EFT authorization form is submitted for each Medicare contractor you submit claims to, and a provider or supplier may only have one EFT account per enrollment.
Account verification
The instructions say all EFT requests go through a pre-certification period in which the financial institution verifies the account before any Medicare direct deposits are made.
Later changes
The form says to notify CMS of any changes in the account in time for the contractor and the financial institution to act on them, and to submit an updated agreement if the financial institution information changes.
Not provider enrollment
The form notes that, under section 1104 of the Affordable Care Act, EFT enrollment is for EFT authorization only and does not constitute enrollment as a provider or supplier in Medicare.
Time to complete
The form estimates an average of 30 minutes per response, including reviewing the instructions and gathering the data needed.
Related forms
CMS-855A
Medicare Enrollment Application - Institutional Providers
1,236 fields, 72 pages
CMS-855B
Medicare Enrollment Application - Clinics/Group Practices and Certain Other Suppliers
960 fields, 54 pages
CMS-855I
Medicare Enrollment Application - Physicians and Non-Physician Practitioners
513 fields, 26 pages
CMS-855S
Medicare Enrollment Application - Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers
1,031 fields, 39 pages
CMS-855O
Medicare Enrollment Application - Registration For Eligible Ordering and Referring Physicians and Non-Physician Practitioners
174 fields, 11 pages
Who uses Form CMS-588?
The form is for Medicare providers and suppliers. Its instructions name these cases.
Official sources and the blank
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Questions about Form CMS-588
Does Form CMS-588 enroll me in Medicare as a provider?
No. The form says EFT enrollment is for electronic funds transfer authorization only and does not constitute enrollment as a provider or supplier in the Medicare program.
Where do I send Form CMS-588?
The instructions say to upload it to PECOS or mail it to the Medicare contractor that services your geographical area. The form warns against mailing it to the PRA Reports Clearance Officer address.
What bank proof does Form CMS-588 ask for?
A confirmation of account information on bank letterhead, with the bank officer's name and signature, or a voided check, in the legal business name. The form says starter checks are not acceptable.
Who signs Form CMS-588?
The instructions say the same Authorized Representative or Delegated Official named on the CMS-855 Medicare enrollment application that the contractor has on file.
Do practitioners who reassign their payments need this form?
The instructions say physicians and individual practitioners who have given a Medicare-enrolled provider or supplier the right to receive payment for all their services are not required to complete it.
Can EFT payments go to a chain home office?
Yes. The form has a Chain Home Office box, and the instructions ask for a letter signed by an authorized official of the provider and of the chain home office.
How many Form CMS-588s are needed?
The instructions say one for each Medicare contractor you submit claims to, and only one EFT account per enrollment.