Participant and NPI
The name or names and address of the participant and the National Provider Identifier (NPI) used to file claims with the MAC.
CMS-460
MEDICARE PARTICIPATING PHYSICIAN OR SUPPLIER AGREEMENT
- Agency
- CMS
- Revision
- 12/28
- Fillable fields
- 11
- Pages
- 3
- Official source
- CMS form page
- Checked
- October 20, 2026
Form CMS-460: Medicare Participating Physician or Supplier Agreement
Form CMS-460, the Medicare Participating Physician or Supplier Agreement, is a Centers for Medicare & Medicaid Services form. The person or organization named on it, called the participant, enters into an agreement with the Medicare program to accept assignment of the Medicare Part B payment for all services it is eligible to accept assignment for while the agreement is in effect. The instructions put it simply: to sign a participation agreement is to agree to accept assignment for all covered services provided to Medicare patients.
Page 1 is the agreement: the participant's names and NPI, three numbered terms, the signature block and a section for the Medicare Administrative Contractor (MAC). Pages 2 and 3 are instructions on when the decision to participate can be made and what to do. The form is sent to the MAC, not to CMS.
The form estimates an average of 15 minutes per response. You can fill it out free in your browser on this page and download the result without an account.
What's on Form CMS-460
1. Meaning of Assignment
Accepting assignment means requesting direct Part B payment from Medicare. The approved charge set by the MAC is the full charge, and the participant does not collect more than the deductible and coinsurance for covered services.
2. Effective Date
A blank for the date the agreement becomes effective if it is filed with a MAC during the enrollment period.
3. Term and Termination
The agreement runs through December 31 and renews automatically each calendar year, unless the participant ends it in writing during the enrollment period or CMS terminates it after notice and a chance for a hearing.
Signature
Signature of the participant or authorized representative, date, title if signing for an organization, and office phone number with area code.
MAC section
Received by (name of MAC), initials of the MAC official and effective date, filled in by the contractor.
How to fill out and send Form CMS-460
- 1
Check the timing
The instructions describe two windows: the open enrollment period near the end of each year for enrolled providers, and the time of enrollment or the 90 days after it for new ones.
- 2
List names and NPI
Enter every name and the NPI under which claims are filed with the MAC this agreement goes to.
- 3
Read the three terms
Review the meaning of assignment, the effective date and how the agreement is renewed and ended.
- 4
Sign and date
The participant, or an authorized representative of an organization with their title, signs and dates the form and adds an office phone number.
- 5
Send it to the MAC
The instructions say to contact the MAC to learn where to send the agreement and the exact dates it is accepted. They say not to send it to CMS, which delays processing.
Why fill Form CMS-460 on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- The official blank straight from the CMS, not a copy someone retyped
- Works on a phone, tablet or computer
Where it goes, timing and help
Where to send it
To the MAC, not CMS. The instructions say sending it to CMS will delay processing, and to contact the MAC for where to send it.
Effective dates
For a new physician, practitioner or supplier, the instructions say the agreement is effective on the date of filing: the postmark date or the date it is delivered to the MAC. A change made during open enrollment starts January 1 of the next year.
Ending participation
The instructions say a current participant who decides not to participate writes to each MAC it submits claims to, with the notice postmarked before the end of the current calendar year, effective the first day of the next.
Fee schedule amounts
The instructions say Medicare fee schedule amounts are 5 percent higher for participants who bill for physicians' professional services, services and supplies incident to them, outpatient physical and occupational therapy, diagnostic tests, or radiology services.
Help with the form
The instructions say to call the MAC in your jurisdiction with questions, and point to cms.gov for MAC contact numbers.
Time to complete
The form estimates an average of 15 minutes per response. Its OMB number is 0938-0373, which the form says expires 12/31/2028.
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Who uses Form CMS-460?
The instructions are addressed to physicians, practitioners and suppliers deciding whether to be Medicare participants.
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Questions about Form CMS-460
What does signing Form CMS-460 mean?
The instructions say that to sign a participation agreement is to agree to accept assignment for all covered services provided to Medicare patients. The agreement covers Medicare Part B payment.
Where do I send Form CMS-460?
To your MAC. The form says not to send it to CMS, because that will delay processing, and to contact the MAC to learn where to send it.
When can an enrolled provider change participation status?
The instructions say during the MAC open enrollment period near the end of each calendar year, generally mid-November through December 31, for the next calendar year. They call this the only time these providers can change status.
How long does a new enrollee have to decide?
The instructions say a newly enrolled physician, practitioner or supplier has 90 days from enrollment to decide to participate and send the CMS-460 to the MAC.
What if a new enrollee does nothing?
The instructions say newly enrolled physicians, practitioners and suppliers are automatically non-participating unless they submit the CMS-460 to their MAC.
Does the agreement renew?
Yes. The form says it continues through December 31 and renews automatically for each January 1 through December 31 period, unless the participant ends it in writing during the enrollment period or CMS terminates it.