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CENTERS FOR MEDICARE & MEDICAID SERVICES. INSTRUCTIONS FOR THE MEDICARE PARTICIPATING PHYSICIAN. AND SUPPLIER AGREEMENT (CMS-460) To sign a participation agreement is to agree to accept assignment for all covered services that you provide to Medicare patients.

The CMS-855R application is used by individual physicians and non-physician practitioners (hereafter collectively referred to as “individual practitioners”) who want to reassign their right to receive Medicare payments to another eligible individual or entity (i.e., sole proprietorship/clinic/group practice/other ...

What is the 855B? ❖ The CMS form used for the enrollment of Clinic/Group practices and Certain Other Suppliers. This form is also used to submit changes to your enrollment data.

What is the 855A? ❖ The Medicare Enrollment Application for Institutional Providers. ❖ This form is also used to submit changes to your enrollment data.

You can complete the Part B SEP online or you can mail your completed CMS 40B, Application for Enrollment in Medicare - Part B (Medical Insurance) and CMS L564 - Request for Employment Information to your local Social Security office.

Centers for Medicare & Medicaid Services.

Physicians and non-physician practitioners can apply for enrollment in the Medicare program or make a change in their enrollment information using either: The Internet-based Provider Enrollment, Chain and Ownership System (PECOS), or • The paper CMS-855I enrollment application.

The 855b is used for Diabetic Education and Mass Immunization while the 855s is for Durable Medical Equipment and non-accredited drugs.