What Does the Medicare 460 Form Mean?

Physicians can choose whether to treat patients and accept payment from Medicare. Physicians who want to be participating providers complete a Medicare 460 form, officially known as a Medicare Participating Physician and Supplier Agreement (CMS-460).

Participating Providers

• Physicians who complete form CMS-460 and become Medicare participating providers agree to accept assignment. This means they will accept Medicare-approved amounts as full payment. When you see a doctor who takes assignment, you only have to pay any deductible or co-insurance. The advantage for the participating doctor is direct reimbursement from Medicare.

Open Enrollment

• Doctors who wish to become participating providers can file form CMS-460 during the open enrollment period, which is usually from mid-November through December 31 each year. This time is also when participating providers can choose to stop participating.

Non-participating Providers

• Physicians who do not participate as Medicare providers can bill you up to 15 percent more than the Medicare-approved amount for most services. You must pay the extra 15 percent in addition to any deductible and coinsurance. Non-participating providers can also ask you to pay up front for services, and then you have to submit your own claims to Medicare for reimbursement.

Physicians Who Opt Out

• Physicians also can opt out of Medicare entirely by filing an affidavit agreeing not to receive payment from Medicare for items or services provided to Medicare patients. These doctors can charge whatever they want, and you have responsibility for the full payment. Medicare will not pay any part of the costs, unless your visit to the doctor was for emergency or urgent care services, or the doctor did not have you sign a written contract explaining payment before you received the services.