Provider Enrollment: Announcement About Medicare Participation for Calendar Year 2025
Table of Contents
- Provider Enrollment: Announcement About Medicare Participation for Calendar Year 2025
- Advantages of Being a Medicare-Participating Provider
- What to Do
- Related Content
Provider Enrollment: Announcement About Medicare Participation for Calendar Year 2025
As you plan for 2025 and learn about changes for the coming year, we wish to remind you of the importance and advantages of being a Medicare-participating provider. We’re pleased that we continued to have a 98% participation rate in 2024. We hope that you’ll help us continue this positive trend by remaining a Medicare-participating provider. Or, if you’re nonparticipating, consider becoming a participating provider for CY 2025.
Advantages of Being a Medicare-Participating Provider
When you’re a Medicare-participating provider:
- You are paid the full Medicare Physician Fee Schedule allowed amount. If you’re a nonparticipating provider, Medicare pays 5% less than the Medicare Physician Fee Schedule allowed amount.
- Medicare pays you directly (on an assignment-related basis).
- Medicare forwards claim information to Medigap (Medicare supplement coverage) insurance (if any).
What To Do
By 12/31/2024, all physicians, practitioners, and suppliers – regardless of their Medicare participation status – must decide whether to participate for CY 2025.
If you’re already participating in Medicare and you want to continue your participation, you don’t need to do anything.
If you’re not currently participating and you want to participate in Medicare next year, complete the Medicare Participating Physician or Supplier Agreement (CMS-460). By signing this agreement, you agree to accept assignment for all covered services that you provide to Medicare patients in CY 2025. Mail a copy to each MAC that you’ll send Part B claims to. Find your MAC's website. If you’re a newly enrolling Medicare provider, you can submit the agreement electronically with your enrollment application.
If you don’t want to participate in Medicare next year and you’re currently participating, write to each MAC that you sent Part B claims to telling them that you don’t want to participate effective 1/1/2025. This written notice must be postmarked before 12/31/2024. Find your MAC's website.
If you’re not currently participating and you don’t want to participate, you don’t need to do anything.
Learn more about Medicare provider enrollment, including the electronic Medicare enrollment system, called the Provider Enrollment, Chain, and Ownership System (PECOS).
Related Content
- MLN® Educational Tool: Medicare Provider Enrollment
- Learn about the electronic Medicare enrollment system, PECOS
- Understanding Participating, Nonparticipating and Opt Out Status
- Announcement About Medicare Participation for Calendar Year 2025
- Calendar Year (CY) 2025 Medicare Physician Fee Schedule Final Rule | CMS
Jurisdiction 6
Jurisdiction K
Reviewed 12/4/2024