Physicians changing their Medicare participation status in 2026 must inform the Centers for Medicare & Medicaid Services (CMS) by Dec. 31.
Those already participating in Medicare who wish to continue in 2026 don’t need to contact CMS. Similarly, physicians who are not currently participating and don’t want to change that status don’t need to act.
The Texas Medical Association reminds physicians, regardless of whether they’re changing or maintaining their status quo, to check their National Plan and Provider Enumeration System (NPPES) information to ensure it has the most correct and updated information, including current practice addresses. Incorrect NPPES data could lead to delayed enrollment with Medicare, Medicaid, and health plans, and create added administrative burden.
Physicians who fall into one of these three categories must act by Dec. 31, per CMS’ website:
Provider Enrollment Services
PO Box 3095
Mechanicsburg, PA 17055-1813
If sending by priority mail or commercial courier, use this address:
Provider Enrollment Services
2020 Technology Parkway, Suite 100
Mechanicsburg, PA 17050
Physicians who are changing from participant to nonparticipant status must inform each MAC they submit Part B claims to that they’re terminating Medicare participation effective Jan. 1, 2026; that mail must be postmarked by Dec. 31.
TMA confirmed CMS does not provide an online option for this notification; it must be done via mail.
Per CMS, Medicare participation means the physician agrees to accept claims assignment for all Medicare-covered services to their patients, agrees to accept Medicare-allowed amounts (per that year’s Medicare physician fee schedule) as payment in full, and is not allowed to collect more from a patient than the Medicare deductible and coinsurance or copayment.
By contrast, CMS says, nonparticipating physicians that accept assignment on a Medicare claim:
Physicians also have an opt-out option not covered by CMS’ recent guidance. That option allows physicians to bypass Medicare payment entirely and allows the physician to enter into a private contract with a Medicare beneficiary.
“To opt out, eligible practitioners must submit an opt-out affidavit,” per Novitas’ website. “This would result in their election to opt out for a mandated two years from the Medicare program and the opt-out will be automatically renewed every two years. Therefore, eligible practitioners are not required to file renewal affidavits every two years.”
The American Medical Association provides an info sheet with more details on the three options.
See the latest updates on Medicare, Medicaid, and commercial health plans via TMA’s Health Plan News.
Last Updated On
November 25, 2025
Originally Published On
November 25, 2025
Phil West
Associate Editor
(512) 370-1394
phil.west[at]texmed[dot]org
Phil West is a writer and editor whose publications include the Los Angeles Times, Seattle Times, Austin American-Statesman, and San Antonio Express-News. He earned a BA in journalism from the University of Washington and an MFA from the University of Texas at Austin’s James A. Michener Center for Writers. He lives in Austin with his wife, children, and a trio of free-spirited dogs.