Deadline Approaching: Physicians Must Update Medicare Participation Status by December 31 Amid Potential Payment Cuts

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:

1. Participating Provider

• Must accept Medicare-allowed charges as full payment.
• Receives 5% higher reimbursement than non-participating providers.

2. 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).

3. 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.