As the new year approaches, CMS is reminding physicians, practitioners, and suppliers to review their Medicare participation status for Calendar Year (CY) 2026. All providers must finalize their decision by December 31, 2025.
Why Participation Matters
Choosing to participate in Medicare offers several key advantages:
- Full reimbursement: Participating providers receive 100% of the Medicare Physician Fee Schedule allowed amount, while non-participating providers receive 5% less.
- Direct payment: Medicare pays participating providers directly on an assignment-related basis.
- Streamlined coordination: Medicare automatically forwards claim information to Medigap insurers when applicable.
Who Doesn’t Need to Take Action?
No action is needed if you:
- Are already a participating provider and want to remain participating, or
- Are currently non-participating and wish to remain so.
Providers who want to change their Medicare participation status should visit CMS’s Annual Medicare Participation Announcement page for instructions and required forms.
Reminder: Keep NPPES Data Current
CMS also encourages all providers to verify their information in the National Plan and Provider Enumeration System (NPPES).
Ensure that:
- Your taxonomy code accurately reflects your provider type, and
- Your practice address is up to date.
Incorrect NPPES data can lead to unnecessary credentialing delays or issues enrolling with Medicare and commercial health plans.