Cms 855r 2025

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The document is a Medicare Enrollment Application (CMS-855R) for the reassignment of Medicare benefits. It outlines the process for individual practitioners and organizations to reassign their rights to bill Medicare and receive payments for services rendered to beneficiaries. The application must be completed by eligible practitioners or organizations, signed by authorized officials, and submitted to the appropriate Medicare Administrative Contractor (MAC). It includes instructions for filling out the form, definitions of terms used, and information on where to send the application.

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Click ‘Get Form’ to open the CMS 855R in the editor.
Begin with Section 1, where you must indicate the reason for submitting this application. Check the appropriate box and provide the effective date.
In Section 2, enter the organization/group receiving the reassigned benefits. Ensure that the legal business name matches IRS records.
Proceed to Section 3 to provide details about the individual practitioner who is reassigning benefits. Fill in all required fields accurately.
If applicable, complete Section 4 for primary and secondary practice locations. Indicate whether you are adding, changing, or removing information.
In Section 5, designate a contact person if needed. This section is optional but can facilitate communication with your designated MAC.
Finally, ensure Sections 6A and/or 6B are signed by both the individual practitioner and an authorized official of the organization/group to validate your application.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (72 Votes)
2016	4.4 Satisfied (320 Votes)
2006	4 Satisfied (26 Votes)

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What is the difference between CMS-855I and 855R?

Use the Medicare Enrollment Application - Physicians and Non-Physician Practitioners (CMS-855I) for individual physicians and practitioners: Enrolling in Medicare for the first time in each state. Reporting changes to previously reported enrollment information.

What is CMS 855R?

❖ 855R. CMS form which establishes a reassignment of your right to bill the Medicare. program and receive Medicare payments. Reassigning your Medicare benefits means that an individual will allow an. eligible Part B provider to submit claims and receive payment for Medicare.

Is the CMS-855R being discontinued?

Starting November 1, 2023, you must use the revised form. Form updates: Combines the CMS-855I and CMS-855R paper applications and discontinues the CMS-855R. Removes physician assistant employer arrangements.

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