Last Modified: 7/29/2022
Location: FL, PR, USVI
Business: Part A, Part B
Q: What is the purpose of the Medicare Participating Physician or Supplier Agreement (CMS-460)?
A: New physicians, practitioners, and suppliers may submit the
CMS-460 form 
at the time of their enrollment. Participants agree to accept assignment for all covered services provided to Medicare patients.
In addition, the CMS-460 may also be used for existing providers during the annual participation open enrollment. The annual physician and supplier participation period begins January 1 of each year, and runs through December 31. The annual participation enrollment is scheduled to begin on November 15 of each year. (Note: The dates listed for release of the participation enrollment/fee disclosure material are subject to publication of the annual Final Rule.)
During the annual enrollment period, for First Coast, the MAC for jurisdiction N (JN), which includes Florida, Puerto Rico, and the U.S. Virgin Islands, submit your completed CMS-460 form (or disenrollment request) to:
Provider Enrollment
P.O. Box 3409
Mechanicsburg, PA 17055-1849
Click here 
to find web addresses for other MACs/carriers. You can locate their mailing addresses for participation enrollment from their websites.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.
