How long does it take to start a DME company and bill Medicare?

No one can promise a timeline. The steps run in sequence, and state boards, accrediting organizations and enrollment contractors each set their own pace. CMS can also pause new enrollments, as it did for medical supply companies in 2026.

Can a new DME company apply to Medicare before it is accredited?

No. CMS's MLN905710 says the enrollment contractors will not process an application unless the applicant is accredited or exempt, and most new DME companies are not exempt.

Do I need a state license before accreditation?

Where your state requires one, yes in practice. Medicare requires licensure wherever a state requires it, and accrediting organizations verify licensure when you apply.

Starting a DME Company: The First Twelve Months

Q: Can I run a DME company from a home office?

Not for Medicare. The location must be at least 200 square feet, accessible to the public, staffed during posted hours with a visible sign, and open at least 30 hours a week under 42 CFR 424.57(c).

Most people who start a DME company underestimate one thing: how much has to exist before the first Medicare claim. Medicare enrollment is the last step of a sequence, not the first, and each step depends on the one before it. The plan below follows the order the rules impose. The months are a planning frame, not a promise; accrediting organizations, state boards and the enrollment contractors set their own pace, and CMS can pause new enrollments entirely, as it did for medical supply companies from February 27 to August 27, 2026.

What should be decided before month one?

What you will supply. Product lines drive everything: which states license you, which accreditation standards apply, whether you need a pharmacist, respiratory therapist or orthotist, and whether Round 2028 competitive bidding affects you (CGMs and insulin pumps, urological and ostomy supplies, hydrophilic catheters and off-the-shelf braces are in it).
Who you will serve. Local walk-in patients, mail-order across states, nursing homes, or a mix. Shipping across state lines multiplies licensing.
Which supplier type you are. The CMS-855S lists more than 80 DMEPOS supplier types. Choose the one that honestly describes your principal business; CMS warned in 2026 that misrepresenting it can bring a 10-year reapplication bar.
Who owns it. Every 5 percent or greater owner is disclosed and fingerprinted. Settle ownership before you file anything, because adding owners later means reporting changes and, for DMEPOS suppliers, high-risk screening again (42 CFR 424.518(c)(1)(vii)).

Which basics come first?

In months 1 and 2, form the entity, get the tax ID and an organizational NPI for the location, and make the legal name, address and TIN match across IRS, NPPES and everything that follows. Then the location. Medicare's supplier standards require a practice location of at least 200 square feet, accessible to the public, staffed during posted hours, with a permanent visible sign, space for records, and a primary business phone at the site that is not a cell phone or an answering service (42 CFR 424.57(c)(7) and (9)). It must be open to the public at least 30 hours a week (424.57(c)(30)) and may not share space with another Medicare provider or supplier, with limited exceptions (424.57(c)(29)). A "closed door" business serving only nursing home residents can qualify if it meets the rest (424.57(c)(7)(iii)).

Sign the lease with those rules in hand. A location in a gated community, an office with no public access, or a suite you share with a physician practice can stop the enrollment months later. See what the site inspector checks.

When do state licenses go in?

As soon as you have the location, usually somewhere in months 2 to 4. Supplier standard 1 requires you to be licensed wherever a state requires licensure to furnish your items (424.57(c)(1)(ii)), and accrediting organizations verify licensure when you apply to them. Start with your home state, then the states you will ship to. Some states inspect first, some require a designated representative or exemptee, and some, like Alabama and Indiana, require a location in the state. Others, like Texas, have no general DME license at all. See DME license requirements by state.

Buy liability insurance in this window too: at least $300,000, covering the place of business, customers and employees, with product liability if you manufacture, signed by your authorized official (424.57(c)(10)). Some states set higher amounts. See insurance requirements.

How does accreditation fit into months 3 to 7?

Accreditation comes before the Medicare application, not after. CMS's MLN905710 fact sheet says the enrollment contractors "won't process any enrollment application unless the applicant is accredited or exempt." The steps are: choose a CMS-approved accrediting organization; write policies and procedures, train staff and set up patient files, delivery records and a complaint log; apply; and pass an unannounced on-site survey. The accreditation must name every product and service you will bill (424.57(c)(22)). Since January 1, 2026, accredited suppliers are resurveyed and reaccredited at least every 12 months (424.57(c)(24)), so the compliance work never stops. See why accreditation comes first and choosing an accrediting organization.

What goes into the Medicare application around months 6 to 8?

The surety bond: $50,000 per NPI from a Treasury-certified surety, with CMS as obligee, plus $50,000 for each adverse legal action in the prior 10 years (424.57(d)). It comes through your own surety agent.
The CMS-855S, on paper or in PECOS, with every owner, managing employee and authorized official, the products you supply, your licenses and your accreditation.
The application fee: $750 for applications in calendar 2026 (CMS-6096-N).
The signature: only your authorized official may sign the initial application's certification (42 CFR 424.510(d)(3)).

Why does the site visit decide months 8 to 10?

New DMEPOS suppliers are screened at the high risk level: the enrollment contractor (NPEAST or NPWEST, depending on your state) arranges an on-site visit and requires fingerprints for an FBI check from every individual with a 5 percent or greater direct or indirect ownership interest (424.518(c)). Be open, staffed and signed during posted hours every day after filing, because the inspector will not call first. Answer development requests quickly. When the contractor approves the enrollment, you receive a PTAN for the location. See high-risk screening.

Do records really have to be in place from the first patient?

Yes. Accreditation surveyors and site inspectors look for the same habits, and the supplier standards spell most of them out. From the first Medicare patient, keep:

Proof of delivery for every item, and a record that the patient received instructions on safe use (424.57(c)(12)).
A written copy of the supplier standards given to each beneficiary you supply (424.57(c)(16)).
Rent or purchase notices for inexpensive or routinely purchased equipment and the purchase option for capped rental items, with documentation that you gave them (424.57(c)(5)).
A complaint resolution protocol and a complaint log covering written, oral and telephone complaints (424.57(c)(19) and (20)).
Ordering and referring documentation for every order (424.57(c)(28)).
Warranty records, since you may not charge the beneficiary or Medicare for warranty repairs (424.57(c)(6)).

Build these into intake and delivery from day one. Retrofitting them before an unannounced resurvey is how small companies fall behind. See what a policy and procedure manual has to cover.

Which payers come after Medicare, in months 10 to 12?

Medicaid in each state you serve, usually after the PTAN. Texas requires Medicare certification first and its own $50,000 Medicaid bond per location; New York requires site-specific Medicare approval and, for nearby suppliers, a walk-in store. See Medicaid DME enrollment.
Commercial and Medicare Advantage plans, or the network managers some plans use. See commercial DME networks.
Competitive bidding, if your products are in Round 2028. Registration runs December 1, 2026 to February 1, 2027 and the bid window January 5 to March 10, 2027 (target dates). A brand-new supplier must be enrolled, accredited and licensed in every required state in PECOS by the close of the window.

Who pays the government and third-party costs?

The new company pays all of them directly: the CMS application fee, each state license and inspection fee, the accrediting organization's fees, fingerprinting, the bond premium and the insurance premium. Bond premiums depend on the surety's underwriting; CMS does not set them. Budget for the rent, staff and inventory you carry before the first Medicare payment too.

Which first-year mistakes are hardest to undo?

A lease that fails the location standards.
Filing the 855S before accreditation.
An accreditation scope that leaves out a product you then bill.
Selling a majority stake within 36 months of enrollment, which forces the buyer to enroll as a new supplier with new accreditation (424.551).
Letting insurance lapse, which revokes billing privileges retroactive to the lapse (424.57(c)(10)(ii)).
Missing the 30-day window to report a change (424.57(c)(2)).

What does it cost to have us prepare the first year?

Our prices: a $149 Readiness Review (credited toward a package) checks your plan against the rules before you sign a lease; state licenses are $699 each ($899 in California, Florida, Georgia and Alabama); Accreditation Readiness is $2,495; the Medicare DMEPOS Enrollment Package is $1,295 for the first location; Medicaid DME Enrollment is $499 per state; Annual Survey Readiness is $1,200 a year once you are accredited. We prepare; your authorized official signs, and we submit in PECOS only as the surrogate your official approves. We never sell equipment or bonds, and no one can promise enrollment or a date. The enrollment hub has the order of operations on one page.