CMS-855R: Reassignment of Medicare Benefits
Authorization form for an individual physician/NPP to reassign their right to collect Medicare payment to a group practice or other eligible entity.
Primary source
CMS-855R Form — CMS.gov →https://www.cms.gov/medicare/cms-forms/cms-forms/downloads/cms855r.pdf
Verified May 23, 2026 · This is the authoritative regulator URL. The summary below is a research aid; the linked source controls.
The CMS-855R authorizes the reassignment of Medicare benefits from an individual physician or NPP to an eligible entity (typically a group practice, hospital, ASC, or clinic).
Reassignment is the structural mechanism by which a group bills Medicare under its TIN for services personally performed by member physicians. Without an effective 855R on file, claims billed by the group for that physician's services will be denied.
Requirements:
- The reassignee must be eligible to receive reassigned benefits (defined at 42 CFR 424.80).
- Both the individual and an authorized official of the reassignee must sign.
- Effective date is the later of receipt by the MAC or the first date the reassignment is otherwise effective.
Termination: either party may terminate the reassignment with notice. The form has a separate Section 6 for termination.
Common operational failure: a physician leaves a group, the group files an 855R termination, but does not coordinate with the new employer to file a fresh 855R timely. Claims for services with the new employer between the termination and the new effective date have no valid reassignment and are denied.
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Related regulations
CMS-855I: Medicare Enrollment Application for Individual Physicians and Non-Physician Practitioners
CMS · CMS EnrollmentCMS-855B: Medicare Enrollment Application for Clinics and Group Practices
CMS · CMS EnrollmentCMS-855O: Medicare Enrollment for Eligible Ordering and Certifying Physicians and Other Eligible Professionals
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Related across the archive
- RegulationCMS-855B: Medicare Enrollment Application for Clinics and Group PracticesThe Medicare enrollment application for clinics, group practices, and certain other suppliers — the primary enrollment vehicle for medical practices that bill Part B.
- RegulationCMS-855I: Medicare Enrollment Application for Individual Physicians and Non-Physician PractitionersIndividual Medicare enrollment vehicle for physicians, NPPs, and certain other individual suppliers; required for any clinician billing Medicare under their own name.
- RegulationCMS-855O: Medicare Enrollment for Eligible Ordering and Certifying Physicians and Other Eligible ProfessionalsAbbreviated Medicare enrollment for clinicians who order or certify items and services for Medicare beneficiaries but do not personally bill Medicare.
- GlossaryCAQH CredentialingThe CAQH ProView database used by most commercial payers to credential providers.
- GlossaryCMS-855 (Medicare Enrollment Application)Family of Medicare enrollment applications: 855A (institutional), 855B (group), 855I (individual), 855O (ordering/referring), 855R (reassignment).
- GlossaryCredentialingThe process by which a payer verifies a provider's qualifications and grants participation in the network.
- GlossaryDeactivationRemoval of a provider from Medicare's enrollment file, typically for failing to revalidate, billing inactivity, or final adverse action.
- GlossaryHospital CredentialingThe process by which a hospital medical staff verifies and grants privileges to a physician.
Last reviewed May 23, 2026 · Citation verified May 23, 2026
Research aid, not legal advice. This summary is an administrative research aid prepared by D3rx. It does not certify compliance, provide legal advice, replace counsel, or guarantee an audit outcome. For authoritative regulatory text follow the primary source link at the top of this page. The practice remains responsible for reviewing, adopting, and maintaining its compliance program.