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Deciding whether to enroll as a Medicare PAR or Non-PAR provider is only half the equation — actually changing that status requires following CMS timelines and paperwork precisely.
This guide walks through the enrollment mechanics referenced in our complete overview of PAR and Non-PAR providers so your practice can make a status change without delays or rejected paperwork.
When Can You Change Your Medicare Participation Status?
Medicare locks most providers into their participation election for a full calendar year. The annual open enrollment window typically runs from mid-November through December 31, with any elected change taking effect January 1 of the following year. Outside of this window, a status change is generally only permitted when a provider experiences a qualifying event, such as relocating a practice to a new Medicare Administrative Contractor (MAC) jurisdiction or joining a new group practice.
The CMS-460 Participation Agreement Explained
New providers and those switching from Non-PAR to PAR must complete Form CMS-460, the Medicare Participating Physician or Supplier Agreement. This form is submitted to your local MAC and formally commits you to accept assignment on all covered Medicare claims. Keep a signed copy on file, since carriers occasionally request proof of the original submission date during audits or disputes.
The 90-Day Window for New Providers
When a provider first enrolls in Medicare, CMS allows 90 days from the date on the Provider Identification Number (PIN) notification letter to submit a participation election. If the signed CMS-460 is postmarked within that 90-day window, the participation effective date is backdated to the postmark date rather than the date the carrier processes it. Missing this window means waiting until the next annual open enrollment cycle to elect PAR status.
Switching From PAR to Non-PAR
Providers who want to drop participating status must submit a signed letter, on practice letterhead, to their MAC before the end of the calendar year. The letter needs an original signature from the provider or an authorized representative and should clearly state the effective date requested. Verbal requests or unsigned emails are not accepted as valid notice.
Becoming a Private Contracting (Opt-Out) Physician
A small number of specialties opt out of Medicare entirely through private contracting, agreeing to bill patients directly and forgo Medicare reimbursement altogether. This requires filing an opt-out affidavit with every Medicare Administrative Contractor with jurisdiction over your claims at least 30 days before the calendar quarter it takes effect, along with signed private contracts with each Medicare patient treated under this arrangement. Opt-out elections automatically renew every two years unless the provider files a request to end the opt-out period.
Check Contractual and State Requirements First
Before filing any status change, confirm you are not contractually bound to remain PAR through a hospital privileging agreement, health plan network contract, or employer requirement. It’s also worth checking your state’s balance-billing statutes, since several states cap or prohibit the amounts Non-PAR providers may collect directly from Medicare beneficiaries beyond the federal limiting charge.
Common Enrollment Mistakes That Delay Status Changes
- Submitting the CMS-460 or opt-out letter without an original signature
- Missing the December 31 deadline for the following year’s status change
- Failing to notify every MAC jurisdiction the practice bills under
- Overlooking existing network or hospital contracts that require PAR status
Getting Medicare enrollment paperwork right the first time avoids months of reimbursement delays. For a full breakdown of how each status affects your fee schedule and collections, see our PAR vs Non-PAR overview, or reach out to our credentialing team at info@medicalbillersandcoders.com for help managing the transition.
How Medical Billers and Coders Can Help With Status Changes
Tracking MAC-specific deadlines, gathering original signatures, and confirming that a CMS-460 or opt-out affidavit reaches every jurisdiction on time is exactly the kind of administrative work that experienced medical billers and coders handle every day. Part of that work includes cross-checking the practice’s PECOS (Provider Enrollment, Chain, and Ownership System) record against the CMS-460 or opt-out affidavit on file, since a mismatch between what was submitted to the MAC and what displays in PECOS can trigger claim rejections even after a status change has been approved.
On the reimbursement side, billing teams also have to recalculate allowables using the correct methodology as soon as a status change takes effect: PAR providers are paid 100% of the Medicare Physician Fee Schedule allowable, while Non-PAR providers are paid 95% of that allowable and may balance-bill unassigned claims up to the 115% limiting charge. Applying the wrong percentage on claims submitted right after a status change is one of the more common causes of underpayments or post-change audit flags, which is why many practices have their medical billers and coders review the first 60-90 days of claims following any participation status change.
Frequently Asked Questions
When is the deadline to change Medicare participation status for the next year?
Providers must submit a signed CMS-460 (to switch to PAR) or a signed election letter (to switch to Non-PAR) to their MAC by December 31, with the change taking effect January 1 of the following year.
What happens if a new provider misses the 90-day election window?
They lose the chance to backdate their effective date to the postmark date and must instead wait until the next annual open enrollment period (mid-November through December 31) to elect PAR status.
Can a provider change participation status outside the annual enrollment window?
Generally no — a mid-year change is only allowed for a qualifying event, such as relocating to a new MAC jurisdiction or joining a new group practice.
What is required to opt out of Medicare through private contracting?
The provider must file an opt-out affidavit with every MAC that has jurisdiction over their claims at least 30 days before the effective calendar quarter, along with signed private contracts with each Medicare patient treated under the arrangement.
Do Medicare opt-out elections need to be renewed?
Yes — opt-out elections automatically renew every two years unless the provider files a request to end the opt-out period.
A Subject Matter Expert in healthcare billing operations with nearly 10 years of experience, sharing insights on claims processing, coding support, and revenue cycle optimization. Dedicated to educating healthcare professionals on compliance, accuracy, and strategies to improve billing performance.
