Form Cms-460 - Medicare Participating Physician Or Supplier Agreement Page 3

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WHAT TO DO IF YOU’RE A NEW PHYSICIAN, PRACTITIONER OR SUPPLIER:
If you choose to be a participant:
• Complete the blank agreement (CMS-460) and submit it with your Medicare enrollment application
to your MAC/carrier.
• If you have already enrolled in the Medicare program, you have 90 days from when you are enrolled
to decide if you want to participate. If you decide to participate within this 90-day timeframe,
complete the CMS-460 and send to your MAC/carrier.
If you decide not to participate:
• Do nothing. All new physicians, practitioners, and suppliers that are newly enrolled are automatically
non-participating. You are not considered to be participating unless you submit the CMS-460 form to
your MAC/carrier.
We hope you will decide to be a Medicare participant.
Please call the MAC/carrier in your jurisdiction if you have any questions or need further information on
participation.
DO NOT SEND YOUR CMS-460 FORM TO CMS, SEND TO YOUR MAC/CARRIER. IF YOU SEND YOUR
FORMS TO CMS, IT WILL DELAY PROCESSING OF YOUR CMS-460 FORMS.
To view updates and the latest information about Medicare, or to obtain telephone numbers of the various
Medicare Administrative Contractor (MAC)/carrier contacts including the MAC/carrier medical directors,
please visit the CMS web site at
Form CMS-460 Instructions (04/10)
3

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