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 ( in early February 2020. Medicare Administrative Contractors will accept current and revised versions of the form through April 30, 2020. Starting May 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 ( for more information about Medicare enrollment.

Contact Palmetto GBA JM Part B Medicare

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Provider Contact Center: 855-696-0705

TDD: 866-830-3188

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