How to Change Medicare PAR Status: 2026 Participation Guide
PAR vs. Non-PAR vs. opt-out, the CMS-460 process, the annual election window, and a practical checklist.
Need the Answer Quickly? Medicare participation status determines whether a provider accepts Medicare's approved amount as payment in full (PAR) or can decide claim by claim (Non-PAR). Changing status generally happens during CMS's annual participation election period, which runs from mid-November through December 31 each year, with the change taking effect January 1 of the following year. To become PAR, a provider submits a signed CMS-460 to their Medicare Administrative Contractor (MAC); to drop PAR status, a provider sends written notice to the MAC before the deadline. New providers get a separate window -- typically 90 days from their enrollment notification -- to make an initial election. None of this is the same as opting out of Medicare entirely, which is a distinct process with its own rules. |
A practice decides mid-year that its Medicare participation status isn't working for its patient mix, and someone starts looking for the fastest way to change it. The honest answer is that there usually isn't a fast way -- Medicare participation status change follows a specific annual timing structure, and outside of a narrow window for newly enrolled providers, that structure doesn't bend for a practice's preferred timing.
This guide walks through what Medicare PAR status actually means, how it differs from Non-PAR and from opting out of Medicare entirely, how and when a provider can change it, what CMS-460 is for, and what a practice should check before assuming a status change will take effect when they expect it to.
What Is Medicare PAR Status?
A participating (PAR) provider has signed a Medicare Participation Agreement and agrees to accept assignment on all covered services furnished to Medicare patients -- meaning they accept Medicare's approved amount as payment in full for every claim, every time.
A nonparticipating (Non-PAR) provider is still enrolled in Medicare and can still bill Medicare, but hasn't signed that agreement. A Non-PAR provider decides assignment on a claim-by-claim basis: they can accept assignment on some claims and not others.
"Accepting assignment" means agreeing to be paid Medicare's allowed amount directly, rather than billing the patient up front and letting the patient seek reimbursement. It's the mechanism that PAR status locks in for every claim and that Non-PAR status leaves flexible.
New providers should note one detail that catches people off guard: when you first enroll in Medicare, or re-enroll under a new tax ID, you start out Non-PAR by default. PAR status isn't automatic -- it requires actively submitting the CMS-460.
Medicare PAR vs. Non-PAR
How to Change Medicare PAR Status
1. Confirm your current status
Check your enrollment record or your MAC's published participation list before assuming which status you currently hold.
2. Identify your Medicare Administrative Contractor
The CMS-460 or termination notice goes to the MAC for your jurisdiction, not to CMS directly -- confirm the correct MAC from your enrollment record rather than an old file.
3. Determine which document you need
Moving to PAR requires a signed CMS-460. Dropping PAR status requires a signed written notice, generally on practice letterhead, sent to the MAC.
4. Confirm the applicable timing window
Status changes generally follow the annual participation election period (mid-November through December 31) unless you qualify for a newly-enrolled-provider window.
5. Submit with an original signature and by the deadline
Electronic or photocopied signatures on these specific documents have been flagged as a common rejection reason -- confirm your MAC's current signature requirements.
6. Notify every MAC jurisdiction you bill under
A multi-state or multi-location practice may need to submit the change separately to each applicable MAC.
7. Confirm the effective status
Follow up with the MAC to confirm the change was processed and will take effect January 1 of the following year, and check the updated MEDPARD listing once published.
8. Update internal billing and patient-facing workflows
Fee schedules, patient billing templates, and front-desk scripting should reflect the new status starting on the effective date, not before.
When Can a Provider Change Medicare Participation Status?
CMS runs an annual participation election period each year, generally mid-November through December 31, letting currently enrolled providers change status effective January 1 of the following year. Providers who want to keep their current status don't need to do anything -- inaction preserves whatever's currently on file.
As of this writing, the CY 2026 election period already closed (November 15 - December 31, 2025, for changes effective January 1, 2026). The next opportunity for most enrolled providers is the window opening mid-November 2026, for changes effective January 1, 2027. Outside that window, currently enrolled providers generally can't change status mid-year.
Newly enrolled providers get a separate window -- typically around 90 days from their enrollment notification -- for an initial election. A CMS-460 postmarked within that window can be backdated to the postmark date. Miss it, and the provider waits for the next annual election period.
Annual Participation Timeline
Mid-Nov | Dec 31 | Jan 1 | MEDPARD Update |
Milestone | What Happens |
Mid-November | CMS's annual participation election period opens |
December 31 | Deadline for submitting a status change for the following calendar year |
January 1 | New participation status takes effect |
After the election period | MACs publish updated MEDPARD participation listings |
What Is CMS-460?
CMS-460 is the Medicare Participating Physician or Supplier Agreement -- the form a provider signs to become or remain a Medicare participating provider, agreeing to accept assignment on all covered services. It's submitted to the provider's MAC, not to CMS directly.
New providers can submit CMS-460 with their initial enrollment application. Already-enrolled providers moving from Non-PAR to PAR submit it during the annual election window (or their initial 90-day window, if newly enrolled). CMS-460 is separate from the Medicare enrollment application itself (the CMS-855 series) -- practices sometimes bundle them into one onboarding process, but the two aren't interchangeable.
PAR vs. Non-PAR vs. Medicare Opt-Out
These three concepts get confused constantly. PAR and Non-PAR both describe providers enrolled and billing Medicare -- the difference is whether assignment is accepted on every claim or decided case by case. Opting out is different entirely: an opted-out provider doesn't bill Medicare at all for covered services. Instead, the provider and patient enter a private contract, the patient pays directly, and neither party submits a Medicare claim (with limited emergency/urgent-care exceptions).
Status | Bills Medicare? | Assignment | Patient Payment |
PAR | Yes | Accepted on all covered services | Patient owes only applicable cost-sharing |
Non-PAR | Yes | Decided claim by claim | Cost-sharing plus limiting charge on unassigned claims |
Opt-out | No | Not applicable | Patient pays the provider directly under a private contract |
Note: Opt-out generally involves its own affidavit and renewal cycle, separate from the annual PAR/Non-PAR election period -- verify current opt-out requirements with CMS or the applicable MAC before assuming the same timing rules apply.
Which Situation Are You In?
I am currently PAR
Confirm whether you want to remain PAR (no action needed) or drop participation, which requires a signed written notice to your MAC before the December 31 deadline.
I am currently Non-PAR
Confirm whether you want to remain Non-PAR (no action needed) or move to PAR by submitting a signed CMS-460 during the election window.
I am newly enrolling
You'll start Non-PAR by default. If you want PAR status, submit CMS-460 within your initial election window -- typically around 90 days from your enrollment notification -- to potentially get a backdated effective date.
I am considering Medicare opt-out
This is a different process from a PAR/Non-PAR election. Verify current opt-out affidavit requirements, timing, and renewal terms directly with CMS or your MAC before proceeding.
How Medicare PAR Status Can Affect Billing
Participation status touches more of the revenue cycle than the reimbursement percentage alone. PAR status locks in assignment on every claim, simplifying patient billing -- patients generally owe only their applicable deductible and coinsurance. Non-PAR status means assignment decisions happen claim by claim, requiring staff to track that decision consistently and calculate the limiting charge correctly on unassigned claims.
PAR status also generally supports automatic Medigap crossover billing, reducing manual secondary-claim work. Enrollment records need to stay consistent across every MAC jurisdiction the practice bills under -- a mismatch between what a MAC has on file and what the practice believes is a common source of claim-level confusion.
Managing Enrollment Across Multiple MACs? Keeping participation status, enrollment records, and revalidation dates consistent across every jurisdiction a practice bills under is an ongoing administrative task, not a one-time filing. Sirius Solutions Global's provider enrollment services can help track and manage that process. |
Common Medicare Participation Mistakes
Mistake | Why It Matters |
Confusing Non-PAR with opting out | These are different arrangements with different billing consequences and different processes |
Missing the December 31 deadline | Status changes generally can't happen mid-year outside the newly-enrolled-provider window |
Assuming a status change is automatic | PAR status requires actively submitting CMS-460 -- it's never the default |
Using outdated timing information | Confirm the current year's election window rather than relying on a prior year's dates |
Failing to verify current participation status before acting | Check the enrollment record or MAC listing rather than assuming |
Overlooking MAC-specific instructions | Submission details can vary by contractor -- confirm with the correct MAC |
Not notifying every applicable MAC jurisdiction | A multi-location practice may need to file separately in each jurisdiction |
Failing to update internal workflows after a status change | Fee schedules and patient billing templates need to reflect the new status starting on the effective date |
Medicare PAR Status Change Checklist
☐ Confirm current Medicare participation status
☐ Review applicable CMS participation requirements and current election window dates
☐ Identify the appropriate Medicare Administrative Contractor
☐ Complete the required documentation (CMS-460 or written notice)
☐ Confirm original-signature and submission requirements with the MAC
☐ Submit the applicable agreement/notification before the deadline
☐ Notify every MAC jurisdiction the practice bills under
☐ Confirm the effective status once processed
☐ Update billing and administrative workflows for the effective date
Where Credentialing Meets the Revenue Cycle
Participation status is one piece of a larger enrollment and credentialing picture -- alongside CMS-855 enrollment, revalidation, and payer-specific credentialing that all need to stay current and consistent across every contractor jurisdiction a practice bills under. Sirius Solutions Global supports healthcare organizations with provider enrollment, Medicare credentialing services, payer enrollment, and broader revenue cycle management.
Frequently Asked Questions
What is Medicare PAR status?
PAR (participating) status means a provider has signed a Medicare Participation Agreement and accepts assignment -- Medicare's allowed amount as payment in full -- on all covered services.
How do I change from Non-PAR to PAR?
Submit a signed CMS-460 to your Medicare Administrative Contractor during the annual participation election period (mid-November through December 31), or within your initial enrollment window if newly enrolled.
What is CMS-460?
The Medicare Participating Physician or Supplier Agreement -- the form used to elect or maintain PAR status, submitted to your MAC.
When can Medicare participation status be changed?
Generally only during the annual election period (mid-November through December 31 each year, effective the following January 1), except for a limited initial window available to newly enrolled providers.
What is the difference between PAR and Non-PAR?
PAR providers accept assignment on every covered claim and receive 100% of the fee schedule amount. Non-PAR providers decide assignment claim by claim and are paid 95% of the PAR amount, with a limiting charge applying to unassigned claims.
Is Non-PAR the same as opting out of Medicare?
No. Non-PAR providers are still enrolled and bill Medicare, just without a blanket assignment agreement. Opted-out providers don't bill Medicare at all and instead use private contracts with patients.
How does Medicare participation affect billing?
It affects the reimbursement rate, whether assignment decisions happen automatically or per claim, patient billing amounts on unassigned claims, and Medigap crossover handling.
Can a credentialing company help with Medicare enrollment and participation?
Yes -- credentialing and provider enrollment support can help track election windows, manage documentation across multiple MAC jurisdictions, and keep enrollment records current.
Sources & References
• CMS -- Medicare Claims Processing Manual and annual Participation Enrollment Program transmittals (e.g., CY 2026 participation enrollment guidance to MACs)
• CMS -- Form CMS-460, Medicare Participating Physician or Supplier Agreement, and accompanying instructions
• CMS -- Medicare Physician Fee Schedule and Non-PAR/limiting charge payment methodology guidance
• Applicable Medicare Administrative Contractor (MAC) -- Jurisdiction-specific participation enrollment instructions and MEDPARD listings
Disclaimer
This article is provided for general educational and informational purposes and does not replace official CMS guidance, your Medicare Administrative Contractor's instructions, or professional credentialing and legal advice. Medicare participation rules, deadlines, forms, and payment methodologies can change and may vary by provider type, enrollment circumstance, and MAC jurisdiction -- verify current requirements directly with CMS or your MAC before making a participation decision. Sirius Solutions Global makes no guarantee regarding enrollment approval, participation status changes, or reimbursement outcomes.