2021 Participation

Published 12/11/2020

Every year you have the opportunity to become a participating provider. The open enrollment period began on November 14, and ends on January 31, 2021.

Annual Participation Enrollment Period Extended to January 31, 2021: Due to the later release of the Medicare Physician Fee Schedule Final Rule, CMS is extending the 2021 annual participation enrollment period for eligible physicians, practitioners, and suppliers. Participation elections and withdrawals must be post-marked on or before January 31, 2021. The effective date for changes remains January 1, 2021.

Please read the Announcement: About Medicare Participation for Calendar Year 2021 as it shares the importance and advantages of being a Medicare participating (PAR) provider.

A participating provider enters into an agreement to accept the Medicare-approved amount as full payment for services and supplies covered under Part B. A participating provider receives five percent more reimbursement than a non-participating provider.

The participation agreement will automatically renew each year. However, if there is a name or EIN (tax identification number) change, you will need to complete a new participation agreement.

If you have not signed a participation agreement, you are listed as non-participating and you are subject to the limiting charge fee schedule.

The participation agreement is completed as follows:

  • Name(s) and Address of Participant: Enter the name and address of the new provider entity
  • Physician or Supplier Identification Code(s): Enter your new Medicare number (PTAN). If your new provider number is pending, enter your tax identification or social security number.
  • Effective Date: Enter the date the CMS-460 form is being delivered or mailed to Palmetto GBA. ‘Beginning of Agreement’ is the date you are mailing your participation agreement to the Palmetto GBA
  • Signature of Participant or Authorized Representative of Participating Organization: Include the provider's signature or authorized representative
  • Title: Enter the title of provider (M.D., etc.) or representative
  • Date: Enter the date the agreement is signed
  • Office Phone Number: Enter the phone number of the practice
  • Received By, Effective Date, Initials of Carrier Official: This section is completed by the Medicare contractor
Note:
  • A group and all members must maintain the same participation status
  • Members joining a group are not required to sign a CMS-460
  • Incorporated or group practitioners must complete a CMS-460 application

Submit a signed Medicare Participating Physician or Supplier Agreement (CMS-460) (PDF, 116 KB) to become a participating provider.

For Jurisdiction J (Alabama, Georgia and Tennessee), send completed forms to:
Palmetto GBA – JJ Part B
Mail Code: AG-310
P.O. Box 100306
Columbia, SC 29202-3306

Please call Palmetto GBA at 877-567-7271 if you have any questions or need further information on participation.

The calendar year 2021 Medicare Physician Fee Schedule and Anesthesia Conversion Factors will soon be available on the Palmetto GBA website after the CY 2021 physician fee schedule regulation is put on display.


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