You may be eligible to participate as a Medicare Participating provider. If you are enrolling as a new entity (even if you are a participating provider under an existing or previous provider number) and wish to be a participating provider, the following Participating Physician or Supplier Agreement must be reviewed and completed.

A Medicare Participating Provider enters into an agreement with the Medicare Program to accept assignment of Medicare Part B payment for all services for which the provider is eligible to accept assignment under Medicare law and regulations.

A Medicare Participating Agreement is in effect through December 31st following the date the agreement becomes effective. An agreement received with an application will be effective on the date of filing, i.e., the date the participant mails (postmark date) the agreement to the carrier or delivers it to the carrier. The agreement will be renewed automatically for each 12-month period beginning January 1st through December 31st.

You do have 90 days from the time you are assigned a Medicare billing number to be a participating provider. But, if you decide to be a participating provider after your Medicare billing number is assigned, the effective date will be the postmark date of the envelope received with the Participating Physician or Supplier Agreement. If your agreement is postmarked after 90 days it will voided and you will be required to wait for the Medicare Participating Open Enrollment (November 15 – December 31^st) to enroll as a participating provider.

Individuals joining an established participating provider, the decision to participate has already been made for the current year and you should not complete the form.

The following practitioners must accept assignment for all Medicare covered services and are not required to complete the form:

• Certified Nurse Midwives
• Certified Registered Nurse Anesthetists
• Clinical Nurse Specialists
• Clinical Psychologists
• Clinical Social Workers
• Nurse Practitioners
• Physician assistants

If you decide to participate, you will be sent a confirmation letter to affirm your participating status in the Medicare program.

This agreement does not have to be completed in order to obtain a Medicare provider billing number.

• Download the CMS 460 - Medicare Participating Physician or Supplier Agreement
• Please visit our Participating vs. Non-Participating area for more information.