Physicians have until December 31, 2024, to update their Medicare participation status for the 2025 calendar year. Changes made will take effect on January 1, 2025, a critical deadline as the 2025 Medicare physician fee schedule reflects a 2.8% payment cut unless Congress intervenes.
Legislative Action to Prevent Payment Cuts
The Medicare Patient Access and Practice Stabilization Act of 2024 (HR 10073), introduced by a bipartisan group of U.S. Representatives, offers hope. This bill, supported by the California Medical Association, aims to stop the 2.8% Medicare payment cut, provide a partial inflation update of 50% of the Medicare Economic Index for 2025, and result in an overall Medicare physician payment increase of 4.73%.
Medicare Participation Options
Physicians have three Medicare participation choices:
- Participating Provider
- Must accept Medicare-allowed charges as full payment.
- Receives 5% higher reimbursement than non-participating providers.
- Non-Participating Provider
- Can choose assignment per claim.
- May bill patients 9.25% above the allowed amount for unassigned claims (15% above non-participating fees).
- Opt-Out of Medicare
- Works under private contracts with patients.
- Medicare’s limiting charges do not apply.
How to Update Your Status
Physicians who wish to change their status for 2025 must submit a signed Medicare Participating Physician or Supplier Agreement (CMS-460) to Noridian, California’s Medicare contractor, postmarked by December 31, 2024. Participation agreements automatically renew unless a name or EIN change requires a new agreement.
For more detailed guidance, refer to the California Medical Association (CMA) health law library, document #7209, “Medicare Participation (and Nonparticipation) Options.” CMA members can access this free, while nonmembers may purchase it for $3 per page.
