The CMS-460 is your agreement to participate in Medicare — meaning you agree to accept Medicare’s approved amount as payment in full for all Medicare-covered services you provide during the calendar year. Signing makes you a “participating provider.”

This is a separate step from enrollment. You can be enrolled in Medicare (via CMS-855I) without being a participating provider. But participation status affects how much you can charge patients, whether you appear in the Medicare physician directory, and how quickly you get paid. For most providers, participation makes sense. Here’s what to know before deciding.

Participating vs. non-participating vs. opted-out

Medicare has three provider status tiers:

Participating provider (signed CMS-460)

Agrees to accept Medicare assignment on all Medicare-covered services
Bills Medicare at the approved fee schedule amount
Cannot charge patients more than copayments and deductibles
Listed in the Medicare Physician Compare directory (now Care Compare)
Receives Medicare payment directly (not through the patient)
Medicare pays 80% of approved amount; patient pays 20%

Non-participating provider (enrolled, no CMS-460)

Can accept or decline assignment on a claim-by-claim basis
When accepting assignment: same as participating
When not accepting assignment: can charge up to 115% of the non-participating fee schedule (which is 95% of the participating fee schedule — so the cap is effectively 109.25% of the participating rate)
Not listed in Medicare physician directory
When not accepting assignment, patient pays out of pocket and must claim reimbursement from Medicare

Opted-out provider (filed opt-out affidavit)

No Medicare reimbursement for any covered services
Can charge patients any amount
Must use private contracts with patients
Full opt-out guide →

Should you sign the CMS-460?

For most Medicare-enrolled providers, participating status is the right choice:

Sign the CMS-460 if:

Your practice is primarily fee-for-service Medicare
You want patients to see you in the Care Compare directory
You want direct Medicare payment (rather than patient-pay-and-claim)
Administrative simplicity matters — one assignment policy for all Medicare claims

Consider non-participating if:

You see Medicare patients infrequently and want flexibility
You practice in a specialty where balance billing above Medicare rates is standard for some services
You want to accept assignment for some services but not others (non-participating allows claim-by-claim choice)

Consider opt-out if:

You want no relationship with Medicare reimbursement
You’re a psychiatrist or specialist whose practice has migrated to direct-pay models
Full opt-out analysis →

Step-by-step: Signing the CMS-460

The CMS-460 is a paper form — there’s no PECOS pathway for this agreement. It’s submitted to your MAC, not through CMS directly.

Step 1: Download the CMS-460 Get the current version from cms.gov. The form is short — one page.

Step 2: Complete the form

Your name and NPI
Practice name and address
Tax ID / EIN
Signature and date
The effective date of participation (typically January 1 of the next calendar year if signing during open enrollment)

Step 3: Submit to your MAC Mail (or in some MACs, fax) to your Medicare Administrative Contractor. Find your MAC at cms.gov/Medicare/Provider-Enrollment-and-Certification.

Timing and enrollment periods

Participation status is a calendar-year election.

Open enrollment: November 15 – January 1 (for the following calendar year)

If you sign the CMS-460 during this window, your participating status is effective January 1 of the next year.

New enrollees: New providers can sign the CMS-460 at any time during their first year of enrollment. Participation becomes effective with your enrollment start date.

Changing status: You can change from non-participating to participating or vice versa only during the November 15 – January 1 open enrollment window. Changes made outside this window take effect the following January 1.

⚠️ Commitment is for a full calendar year. Once you’ve agreed to participate for a year (by signing or by failing to opt out), you’re bound for that year. You can’t decide mid-year that you want to balance bill.

⚠️ Risk flags

⚠️ Missing the enrollment window. New providers who miss the initial opportunity to sign the CMS-460 must wait until the next November-January window. In the meantime, they’re non-participating by default.

⚠️ Participation applies to all services, not just some. Participating providers accept assignment on every Medicare-covered claim. You can’t participate for some patients and balance bill others.

⚠️ The directory matters. Patients actively search Care Compare for participating providers. Non-participating providers are not listed. For practices that depend on Medicare patients finding them, this is a meaningful visibility difference.

After signing

Your MAC updates your record. Your participating status takes effect on the date specified. You’ll appear in Medicare’s Care Compare directory within 30–60 days of the effective date.

No additional annual filing is required once you’re participating — your status carries forward year to year unless you notify your MAC of a change during open enrollment.

Questions about participation status and what it means for your practice? Ask Mae →