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Attestation
In order to remain compliant with federal regulations, please read the attestation below regarding the license for use of Physicians’ Current Procedural Terminology, Fourth Edition (CPT) codes and Healthcare Common Procedure Coding system (HCPCS) codes. Should you choose not to accept, you will be unable to view the information within the provider/supplier sections of this site. LICENSE FOR USE OF "Physicians' CURRENT PROCEDURAL TERMINOLOGY", FOURTH EDITION ("CPT") CPT codes, descriptions and other data only are copyright 1999 American Medical Association (AMA). All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA. You, your employees, and agents are authorized to use CPT only as contained in the following authorized materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement. Local coverage determinations (LCDs) Bulletins/newsletters Program Memoranda and instructions Coverage issues and Medicare coding policies Program integrity bulletins and information Educational training materials, including computer-basic training modules Fee schedules Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the AMA, CPT Intellectual Property Services, 515 North State Street, Chicago, Illinois 60610. Applications are available at the AMA Web site, http://www.amaassn.org/ama/pub/category/3113.html. Applicable Federal Acquisition Regulations System (FARS)/Defense Federal Acquisition Regulation Supplement (DFARS) restrictions apply to government use. U.S. Government Rights This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)(June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements. AMA Disclaimer of Warranties and Liabilities CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. The AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. The AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with (insert name of applicable entity) or CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement. CMS Disclaimer The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. End Users do not act for or on behalf of CMS. The CMS disclaims responsibility for any liability attributable to end user use of the CPT. The CMS will not be liable for any claims attributable to any errors, omissions, or other inaccuracies in the information or material contained on this page. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on "ACCEPT".
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CHANGE EXISTING PROVIDER ENROLLMENT INFORMATION
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Time Requirements to Notify Medicare of Changes
Report Changes to your Enrollment Records
Verify NPI with NPPES Registry
Description of NPI and a Link to NPPES Registry
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Make Necessary Changes to the Existing Enrollment
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Physician Assistant
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Physicians or Nonphysician Practitioners with/without Private Practice
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Terminating a Physician Assistant Employment Arrangement
Terminating (by PA, Sole Owner or Sole Proprietor)
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Complete sections 1, 2A, 2I, 3, 13 and 15.
Terminating (by Group)
CMS-855B
(CMS-855R not needed)
Complete sections 1, 2, 2G, 3 and 15 or 16.
Terminating a Physician Assistant Employment Arrangement
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