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Reassignment of Medicare Benefits: Revised CMS-855R Required May 1

Physicians and non-physician practitioners: Use the revised CMS-855R (Reassignment of Benefits) application once it is posted on the CMS Forms List (go.usa.gov/cuu5Y) in early February 2020. Medicare Administrative Contractors will accept current and revised versions of the form through 4/30/2020. Starting 5/1/2020 you must use the revised form. Form updates:

  • Can select Change of Reassignment Information as submission reason

  • Option to identify a secondary practice address

Visit the Medicare Provider-Supplier Enrollment webpage (go.usa.gov/cuujB) for more information about Medicare enrollment.

Posted 2/7/2020


Last Modified: 2/7/20
Reassignment of Medicare Benefits: Revised CMS-855R Required May 1
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