CMS Preclusion List
also known as: Preclusion List · Medicare Advantage preclusion list
A confidential CMS list of prescribers and providers whose claims Medicare Advantage and Part D plans must reject.
The CMS Preclusion List is a list maintained by the Centers for Medicare & Medicaid Services (CMS) identifying prescribers and providers whose claims and prescriptions must be denied by Medicare Advantage (Part C) plans and Part D prescription drug plans.
A provider lands on the Preclusion List if they are (1) currently revoked from Medicare and under an active re-enrollment bar, (2) have engaged in behavior CMS determines is detrimental to Medicare even without a formal revocation, or (3) have been convicted of a felony CMS deems detrimental within the prior 10 years.
The Preclusion List is distinct from the OIG exclusion (LEIE) regime. It is not public — CMS shares it confidentially with MA and Part D plans — and it specifically governs payment under Medicare Advantage and Part D rather than all federal healthcare programs. It replaced the earlier Part D prescriber enrollment requirement in 2019.
EXAMPLE
A prescriber revoked from Medicare with an active re-enrollment bar is added to the Preclusion List, so Part D plans must reject their prescriptions at the pharmacy counter.RELATED TERMS
Screen a provider against the CMS Preclusion List
Enter an NPI or name to check OIG LEIE, SAM.gov, state board sanctions, state Medicaid exclusions, OFAC SDN, and FDA debarment in a single lookup.
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