medicare participation vs assignment

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What is Medicare assignment and how does it work?

Kimberly Lankford,

​Because Medicare decides how much to pay providers for covered services, if the provider agrees to the Medicare-approved amount, even if it is less than they usually charge, they’re accepting assignment.

A doctor who accepts assignment agrees to charge you no more than the amount Medicare has approved for that service. By comparison, a doctor who participates in Medicare but doesn’t accept assignment can potentially charge you up to 15 percent more than the Medicare-approved amount.

That’s why it’s important to ask if a provider accepts assignment before you receive care, even if they accept Medicare patients. If a doctor doesn’t accept assignment, you will pay more for that physician’s services compared with one who does.

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How much do I pay if my doctor accepts assignment?

If your doctor accepts assignment, you will usually pay 20 percent of the Medicare-approved amount for the service, called coinsurance, after you’ve paid the annual deductible. Because Medicare Part B covers doctor and outpatient services, your $240 deductible for Part B in 2024 applies before most coverage begins.

All providers who accept assignment must submit claims directly to Medicare, which pays 80 percent of the approved cost for the service and will bill you the remaining 20 percent. You can get some preventive services and screenings, such as mammograms and colonoscopies , without paying a deductible or coinsurance if the provider accepts assignment. 

What if my doctor doesn’t accept assignment?

A doctor who takes Medicare but doesn’t accept assignment can still treat Medicare patients but won’t always accept the Medicare-approved amount as payment in full.

This means they can charge you up to a maximum of 15 percent more than Medicare pays for the service you receive, called “balance billing.” In this case, you’re responsible for the additional charge, plus the regular 20 percent coinsurance, as your share of the cost.

How to cover the extra cost? If you have a Medicare supplement policy , better known as Medigap, it may cover the extra 15 percent, called Medicare Part B excess charges.

All Medigap policies cover Part B’s 20 percent coinsurance in full or in part. The F and G policies cover the 15 percent excess charges from doctors who don’t accept assignment, but Plan F is no longer available to new enrollees, only those eligible for Medicare before Jan. 1, 2020, even if they haven’t enrolled in Medicare yet. However, anyone who is enrolled in original Medicare can apply for Plan G.

Remember that Medigap policies only cover excess charges for doctors who accept Medicare but don’t accept assignment, and they won’t cover costs for doctors who opt out of Medicare entirely.

Good to know. A few states limit the amount of excess fees a doctor can charge Medicare patients. For example, Massachusetts and Ohio prohibit balance billing, requiring doctors who accept Medicare to take the Medicare-approved amount. New York limits excess charges to 5 percent over the Medicare-approved amount for most services, rather than 15 percent.

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How do I find doctors who accept assignment?

Before you start working with a new doctor, ask whether he or she accepts assignment. About 98 percent of providers billing Medicare are participating providers, which means they accept assignment on all Medicare claims, according to KFF.

You can get help finding doctors and other providers in your area who accept assignment by zip code using Medicare’s Physician Compare tool .

Those who accept assignment have this note under the name: “Charges the Medicare-approved amount (so you pay less out of pocket).” However, not all doctors who accept assignment are accepting new Medicare patients.

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What does it mean if a doctor opts out of Medicare?

Doctors who opt out of Medicare can’t bill Medicare for services you receive. They also aren’t bound by Medicare’s limitations on charges.

In this case, you enter into a private contract with the provider and agree to pay the full bill. Be aware that neither Medicare nor your Medigap plan will reimburse you for these charges.

In 2023, only 1 percent of physicians who aren’t pediatricians opted out of the Medicare program, according to KFF. The percentage is larger for some specialties — 7.7 percent of psychiatrists and 4.2 percent of plastic and reconstructive surgeons have opted out of Medicare.

Keep in mind

These rules apply to original Medicare. Other factors determine costs if you choose to get coverage through a private Medicare Advantage plan . Most Medicare Advantage plans have provider networks, and they may charge more or not cover services from out-of-network providers.

Before choosing a Medicare Advantage plan, find out whether your chosen doctor or provider is covered and identify how much you’ll pay. You can use the Medicare Plan Finder to compare the Medicare Advantage plans and their out-of-pocket costs in your area.

Return to Medicare Q&A main page

Kimberly Lankford is a contributing writer who covers Medicare and personal finance. She wrote about insurance, Medicare, retirement and taxes for more than 20 years at  Kiplinger’s Personal Finance  and has written for  The Washington Post  and  Boston Globe . She received the personal finance Best in Business award from the Society of American Business Editors and Writers and the New York State Society of CPAs’ excellence in financial journalism award for her guide to Medicare.

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If you have Original Medicare , your Part B costs once you have met your deductible can vary depending on the type of provider you see. For cost purposes, there are three types of provider, meaning three different relationships a provider can have with Medicare . A provider’s type determines how much you will pay for Part B -covered services.

• These providers are required to submit a bill (file a claim ) to Medicare for care you receive. Medicare will process the bill and pay your provider directly for your care. If your provider does not file a claim for your care, there are troubleshooting steps to help resolve the problem .
• If you see a participating provider , you are responsible for paying a 20% coinsurance for Medicare-covered services.
• Certain providers, such as clinical social workers and physician assistants, must always take assignment if they accept Medicare.
• Non-participating providers can charge up to 15% more than Medicare’s approved amount for the cost of services you receive (known as the limiting charge ). This means you are responsible for up to 35% (20% coinsurance + 15% limiting charge) of Medicare’s approved amount for covered services.
• Some states may restrict the limiting charge when you see non-participating providers. For example, New York State’s limiting charge is set at 5%, instead of 15%, for most services. For more information, contact your State Health Insurance Assistance Program (SHIP) .
• If you pay the full cost of your care up front, your provider should still submit a bill to Medicare. Afterward, you should receive from Medicare a Medicare Summary Notice (MSN) and reimbursement for 80% of the Medicare-approved amount .
• The limiting charge rules do not apply to durable medical equipment (DME) suppliers . Be sure to learn about the different rules that apply when receiving services from a DME supplier .
• Medicare will not pay for care you receive from an opt-out provider (except in emergencies). You are responsible for the entire cost of your care.
• The provider must give you a private contract describing their charges and confirming that you understand you are responsible for the full cost of your care and that Medicare will not reimburse you.
• Opt-out providers do not bill Medicare for services you receive.
• Many psychiatrists opt out of Medicare.

Providers who take assignment should submit a bill to a Medicare Administrative Contractor (MAC) within one calendar year of the date you received care. If your provider misses the filing deadline, they cannot bill Medicare for the care they provided to you. However, they can still charge you a 20% coinsurance and any applicable deductible amount.

Be sure to ask your provider if they are participating, non-participating, or opt-out. You can also check by using Medicare’s Physician Compare tool .

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Medicare Assignment

Home / Medicare 101 / Medicare Costs / Medicare Assignment

Summary: If a provider accepts Medicare assignment, they accept the Medicare-approved amount for a covered service. Though most providers accept assignment, not all do. In this article, we’ll explain the differences between participating, non-participating, and opt-out providers. You’ll also learn how to find physicians in your area who accept Medicare assignment. Estimated Read Time: 5 min

What is Medicare Assignment

Medicare assignment is an agreement by your doctor or other healthcare providers to accept the Medicare-approved amount as the full cost for a covered service. Providers who “accept assignment” bill Medicare directly for Part B-covered services and cannot charge you more than the applicable deductible and coinsurance.

Most healthcare providers who opt-in to Medicare accept assignment. In fact, CMS reported in its Medicare Participation for Calendar Year 2024 announcement that 98 percent of Medicare providers accepted assignment in 2023.

Providers who accept Medicare are divided into two groups: Participating providers and non-participating providers. Providers can decide annually whether they want to participate in Medicare assignment, or if they want to be non-participating.

Providers who do not accept Medicare Assignment can charge up to 15% above the Medicare-approved cost for a service. If this is the case, you will be responsible for the entire amount (up to 15%) above what Medicare covers.

Below, we’ll take a closer look at participating, non-participating, and opt-out physicians.

Medicare Participating Providers: Providers Who Accept Medicare Assignment

Healthcare providers who accept Medicare assignment are known as “participating providers”. To participate in Medicare assignment, a provider must enter an agreement with Medicare called the Participating Physician or Supplier Agreement. When a provider signs this agreement, they agree to accept the Medicare-approved charge as the full charge of the service. They cannot charge the beneficiary more than the applicable deductible and coinsurance for covered services.

Each year, providers can decide whether they want to be a participating or non-participating provider. Participating in Medicare assignment is not only beneficial to patients, but to providers as well. Participating providers get paid by Medicare directly, and when a participating provider bills Medicare, Medicare will automatically forward the claim information to Medicare Supplement insurers. This makes the billing process much easier on the provider’s end.

Medicare Non-Participating Providers: Providers Who Don’t Accept Assignment

Healthcare providers who are “non-participating” providers do not agree to accept assignment and can charge up to 15% over the Medicare-approved amount for a service. Non-participating Medicare providers still accept Medicare patients. However they have not agreed to accept the Medicare-approved cost as the full cost for their service.

Doctors who do not sign an assignment agreement with Medicare can still choose to accept assignment on a case-by-case basis. When non-participating providers do add on excess charges , they cannot charge more than 15% over the Medicare-approved amount. It’s worth noting that providers do not have to charge the maximum 15%; they may only charge 5% or 10% over the Medicare-approved amount.

When you receive a Medicare-covered service at a non-participating provider, you may need to pay the full amount at the time of your service; a claim will need to be submitted to Medicare for you to be reimbursed. Prior to receiving care, your provider should give you an Advanced Beneficiary Notice (ABN) to read and sign. This notice will detail the services you are receiving and their costs.

Non-participating providers should include a CMS-approved unassigned claim statement in the additional information section of your Advanced Beneficiary Notice. This statement will read:

“This supplier doesn’t accept payment from Medicare for the item(s) listed in the table above. If I checked Option 1 above, I am responsible for paying the supplier’s charge for the item(s) directly to the supplier. If Medicare does pay, Medicare will pay me the Medicare-approved amount for the item(s), and this payment to me may be less than the supplier’s charge.”

This statement basically summarizes how excess charges work: Medicare will pay the Medicare-approved amount, but you may end up paying more than that.

Your provider should submit a claim to Medicare for any covered services, however, if they refuse to submit a claim, you can do so yourself by using CMS form 1490S .

Opt-Out Providers: What You Need to Know

Opt-out providers are different than non-participating providers because they completely opt out of Medicare. What does this mean for you? If you receive supplies or services from a provider who opted out of Medicare, Medicare will not pay for any of it (except for emergencies).

Physicians who opt-out of Medicare are even harder to find than non-participating providers. According to a report by KFF.org, only 1.1% of physicians opted out of Medicare in 2023. Of those who opted out, most are physicians in specialty fields such as psychiatry, plastic and reconstructive surgery, and neurology.

How to Find A Doctor Who Accepts Medicare Assignment

Finding a doctor who accepts Medicare patients and accepts Medicare assignment is generally easier than finding a provider who doesn’t accept assignment. As we mentioned above, of all the providers who accept Medicare patients, 98 percent accept assignment.

The easiest way to find a doctor or healthcare provider who accepts Medicare assignment is by visiting Medicare.gov and using their Compare Care Near You tool . When you search for providers in your area, the Care Compare tool will let you know whether a provider is a participating or non-participating provider.

If a provider is part of a group practice that involves multiple providers, then all providers in that group must have the same participation status. As an example, we have three doctors, Dr. Smith, Dr. Jones, and Dr. Shoemaker, who are all part of a group practice called “Health Care LLC”. The group decides to accept Medicare assignment and become a participating provider. Dr. Smith decides he does not want to accept assignment, however, because he is part of the “Health Care LLC” group, he must remain a participating provider.

Using Medicare’s Care Compare tool, you can select a group practice and see their participation status. You can then view all providers who are part of that group. This makes finding doctors who accept assignment even easier.

To ensure you don’t end up paying more out-of-pocket costs than you anticipated, it’s always a good idea to check with your provider if they are a participating Medicare provider. If you have questions regarding Medicare assignment or are having trouble determining whether a provider is a participating provider, you can contact Medicare directly at 1-800-633-4227. If you have questions about excess charges or other Medicare costs and would like to speak with a licensed insurance agent, you can contact us at the number above.

Announcement About Medicare Participation for Calendar Year 2024, Centers for Medicare & Medicaid Services. Accessed January 2024

https://www.cms.gov/files/document/medicare-participation-announcement.pdf

Annual Medicare Participation Announcement, CMS.gov. Accessed January 2024

https://www.cms.gov/medicare-participation

Does Your Provider Accept Medicare as Full Payment? Medicare.gov. Accessed January 2024

https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare

Thomas Liquori

Ashlee Zareczny

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Medicare Options

To help ensure that physicians are making informed decisions about their contractual relationships with the Medicare program, the AMA has developed a “Medicare Participation Kit”(www.ama-assn.org) that explains the various participation options that are available to physicians. A summary of those options is presented below. The AAFP is not advising or recommending any of the options. The purpose of sharing this information is merely to ensure that physician decisions about Medicare participation are made with complete information about the available options. Please note that the summary below does not account for any payment adjustments that a participating or non-participating physician may incur through one of the Medicare initiatives, such as the Physician Quality Reporting System. Physicians wishing to change their Medicare participation or non-participation status for a given year are usually required to do so by December 31 of the prior year (e.g., December 31, 2015 for 2016). Participation decisions are effective January 1 of the year in question and are binding for the entire year.

The Three Options

There are basically three Medicare contractual options for physicians. Physicians may sign a participating (PAR) agreement and accept Medicare's allowed charge as payment in full for all of their Medicare patients. They may elect to be a non-PAR physician, which permits them to make assignment decisions on a case-by-case basis and to bill patients for more than the Medicare allowance for unassigned claims. Or they may become a private contracting physician, agreeing to bill patients directly and forego any payments from Medicare to their patients or themselves. Physicians who wish to change their status from PAR to non-PAR or vice versa may do so annually. Once made, the decision is generally binding until the next annual contracting cycle except where the physician's practice situation has changed significantly, such as relocation to a different geographic area or a different group practice. To become a private contractor, physicians must give 30 days notice before the first day of the quarter the contract takes effect. Those considering a change in status should first determine that they are not bound by any contractual arrangements with hospitals, health plans or other entities that require them to be PAR physicians. In addition, some states have enacted laws that prohibit physicians from balance billing their patients.

Participation

PAR physicians agree to take assignment on all Medicare claims, which means that they must accept Medicare's approved amount (which is the 80% that Medicare pays plus the 20% patient copayment) as payment in full for all covered services for the duration of the calendar year. The patient or the patient's secondary insurer is still responsible for the 20% copayment but the physician cannot bill the patient for amounts in excess of the Medicare allowance. While PAR physicians must accept assignment on all Medicare claims, however, Medicare participation agreements do not require physician practices to accept every Medicare patient who seeks treatment from them.

Medicare provides a number of incentives for physicians to participate:

• The Medicare payment amount for PAR physicians is 5% higher than the rate for non-PAR physicians.
• Directories of PAR physicians are provided to senior citizen groups and individuals who request them.
• Medicare administrative contractors (MAC) provide toll-free claims processing lines to PAR physicians and process their claims more quickly.

Non-Participation

Medicare approved amounts for services provided by non-PAR physicians (including the 80% from Medicare plus the 20% copayment) are set at 95% of Medicare approved amounts for PAR physicians, although non-PAR physicians can charge more than the Medicare approved amount.

Limiting charges for non-PAR physicians are set at 115% of the Medicare approved amount for non-PAR physicians. However, because Medicare approved amounts for non-PAR physicians are 95% of the rates for PAR physicians, the 15% limiting charge is effectively only 9.25% above the PAR approved amounts for the services. Therefore, when considering whether to be non-PAR, physicians must determine whether their total revenues from Medicare, patient copayments and balance billing would exceed their total revenues as PAR physicians, particularly in light of collection costs, bad debts and claims for which they do accept assignment. The 95% payment rate is not based on whether physicians accept assignment on the claim, but whether they are PAR physicians; when non-PAR physicians accept assignment for their low-income or other patients, their Medicare approved amounts are still only 95% of the approved amounts paid to PAR physicians for the same service. Non-PAR physicians would need to collect the full limiting charge amount roughly 35% of the time they provided a given service in order for the revenues from the service to equal those of PAR physicians for the same service. If they collect the full limiting charge for more than 35% of the services that they provide, their Medicare revenues will exceed those of PAR physicians.

Assignment acceptance, for either PAR or non-PAR physicians, also means that the MAC pays the physician the 80% Medicare payment. For unassigned claims, even though the physician is required to submit the claim to Medicare, the program pays the patient, and the physician must then collect the entire amount for the service from the patient.

Example: A service for which Medicare fee schedule amount is $100

Private Contracting

Provisions in the Balanced Budget Act of 1997 give physicians and their Medicare patients the freedom to privately contract to provide health care services outside the Medicare system. Private contracting decisions may not be made on a case-by-case or patient-by-patient basis, however. Once physicians have opted out of Medicare, they cannot submit claims to Medicare for any of their patients for a two-year period.

A physician who has not been excluded under sections 1128, 1156 or 1892 of the Social Security Act may, however, order, certify the need for, or refer a beneficiary for Medicare-covered items and services, provided the physician is not paid, directly or indirectly, for such services (except for emergency and urgent care services). For example, if a physician who has opted out of Medicare refers a beneficiary for medically necessary services, such as laboratory, DMEPOS or inpatient hospitalization, those services would be covered by Medicare.

To privately contract with a Medicare beneficiary, a physician must enter into a private contract that meets specific requirements, as set forth in the sample private contract below. In addition to the private contract, the physician must also file an affidavit that meets certain requirements, as contained in the sample affidavit below. To opt out, a physician must file an affidavit that meets the necessary criteria and is received by the MAC at least 30 days before the first day of the next calendar quarter. There is a 90-day period after the effective date of the first opt-out affidavit during which physicians may revoke the opt-out and return to Medicare as if they had never opted out.

Emergency and Urgent Care Services Furnished During the "Opt-Out" Period

Physicians who have opted-out of Medicare under the Medicare private contract provisions may furnish emergency care services or urgent care services to a Medicare beneficiary with whom the physician has previously entered into a private contract so long as the physician and beneficiary entered into the private contract before the onset of the emergency medical condition or urgent medical condition. These services would be furnished under the terms of the private contract.

Physicians who have opted-out of Medicare under the Medicare private contract provisions may continue to furnish emergency or urgent care services to a Medicare beneficiary with whom the physician has not previously entered into a private contract, provided the physician:

• Submits a claim to Medicare in accordance with both 42 CFR part 424 (relating to conditions for Medicare payment) and Medicare instructions (including but not limited to complying with proper coding of emergency or urgent care services furnished by physicians and qualified health care professionals who have opted-out of Medicare).
• Collects no more than the Medicare limiting charge, in the case of a physician (or the deductible and coinsurance, in the case of a qualified health care professional).

Note that a physician who has been excluded from Medicare must comply with Medicare regulations relating to scope and effect of the exclusion (42 C.F.R. § 1001.1901) when the physician furnishes emergency services to beneficiaries, and the physician may not bill and be paid for urgent care services.

Sample Medicare Private Contract and Affidavit

The sample private contract and affidavit below contain the provisions that Medicare requires (unless otherwise noted) to be included in these documents.

Private contracts must meet specific requirements:

• The physician must sign and file an affidavit agreeing to forgo receiving any payment from Medicare for items or services provided to any Medicare beneficiary for the following 2-year period (either directly, on a capitated basis or from an organization that received Medicare reimbursement directly or on a capitated basis).
• Medicare does not pay for the services provided or contracted for. The contract must be in writing and must be signed by the beneficiary before any item or service is provided.
• The contract cannot be entered into at a time when the beneficiary is facing an emergency or an urgent health situation.

In addition, the contract must state unambiguously that by signing the private contract, the beneficiary:

• gives up all Medicare payment for services furnished by the "opt out" physician;
• agrees not to bill Medicare or ask the physician to bill Medicare;
• is liable for all of the physician's charges, without any Medicare balance billing limits;
• acknowledges that Medigap or any other supplemental insurance will not pay toward the services; and acknowledges that he or she has the right to receive services from physicians for whom Medicare coverage and payment would be available.

If you determine that you want to "opt out" of Medicare under a private contract, we recommend that you consult with your attorney to develop a valid contract containing other standard non-Medicare required provisions that generally are included in any standard contract.

Download sample contracts:

• Sample Medicare Private Contract
• Sample Medicare Private Contracts "Opt-Out" Affidavit

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Understanding Medicare Participation and Non-Participation

Understand how physicians who are identified by the Medicare program as non-participating may still provide care for Medicare beneficiaries and receive payment by the program. Learn how Medicare sets different payment levels for services provided by participating and non-participating physicians.

The downside to being a non-participating physician is that the maximum Medicare payment amount is set at 95% of the amount paid for the same service when furnished by a participating physician. The positive aspect of non-participation is the ability to bill above the RVS amount. While balance billing does increase a non-participating physician’s total payment, it is limited to 115% of the allowed amount. Consider the following chart:

Most claims for physician services are submitted on an assigned basis, and participating physicians submit the vast majority of these claims.

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Physicians have three ways to participate in Medicare:

• Sign a participation (PAR) agreement.
• Elect nonparticipation (nonPAR).
• Become a private contracting physician (opt out).

Participating (PAR)

Participating in the Medicare program simply means you agree to accept assignment for all services furnished to Medicare patients. By accepting assignment, you agree to accept the Medicare-approved amount as total payment for covered services.

• The deductible and coinsurance are applied to covered services. The beneficiary is responsible for these amounts.
• If both Medicare and Medicaid cover a beneficiary, the Medicaid program assumes responsibility for these amounts.

When you enroll as a new provider, or reenroll due to a tax identification number change, you start as a nonparticipating provider. You are not considered participating unless you submit the CMS-460 form to your MAC/carrier.

• To become a participating provider at the time of enrollment, you have to change your participation status. You must do so within 90 days of the date of your Provider Transaction Access Number notification.
• If CMS receives a PAR agreement within 90 days of your enrollment, it will use the postmark date on the envelope as your PAR effective date.
• If you decide to enroll as a Medicare participating provider after the 90-day grace period, you must wait. Complete your form during open enrollment.

Once a participant, you must remain a participant until the following annual enrollment period.

Nonparticipating (NonPAR)

If you choose not to participate in the Medicare program, you may choose either to accept or not accept assignment on Medicare claims on a claim-by-claim basis. If you choose not to accept assignment:

• You may not charge the beneficiary more than the Medicare limiting charge for unassigned claims for Medicare services.
• Physicians must collect payment directly from the beneficiary who is responsible for submitting their claim to Medicare for the allowable.
• The limiting charge applies. The limiting charge is 115 percent of the Physician Fee Schedule amount. The beneficiary is not responsible for billed amounts in excess of the limiting charge for a covered service. The limiting charge applies to all services and supplies billed under the physician fee schedule — including drugs and biologicals — regardless of the provider rendering the services.
• Be sure never to charge patients more than the limiting charge amount. Physicians who do charge more will be subject to a civil monetary penalty if they willfully, knowingly or repeatedly charge a higher amount. The penalty may be up to $10,000 per violation, as well as three times the amount of the charges claimed per violation. The physician may also be excluded from the Medicare program for five years. 

CMS provides instructions for patients on how to file a claim/claim form [PDF].

Changing Your Participation Status

To change your participation status from nonPAR to PAR, you must submit the CMS-460 form signed by the provider or authorized official of the National Provider Identifier requesting the change.

To change your participation status from PAR to nonPAR for the upcoming year, you must submit a letter on a provider letterhead to your local Medicare contractor stating your intent, postmarked by Dec. 31 of the current year. The letter should include all of the following:

• Provider Transaction Access Number
• National Provider Identifier
• Tax identification number/Employer Identification Number/Social Security number

The request should be signed by the provider or an authorized official for the National Provider Identifier requesting the change.

If you’re considering a change in status from PAR to Non-PAR, you should first confirm whether you have any contractual arrangements with hospitals, health plans or other entities that require you to be a PAR physician.

Opting Out of Medicare

Physicians and practitioners who do not wish to enroll in the Medicare program may “opt out” of Medicare. When you opt out:

• Neither the physician nor the beneficiary submits the bill to Medicare for services rendered.
• The beneficiary pays the physician out of pocket.
• Neither party is reimbursed by Medicare.

Once you have opted out of Medicare, you cannot submit claims to Medicare for any of your patients for a two-year period. In order to opt out:

• You and the beneficiary must sign a private contract that states that neither of you can receive payment from Medicare for the services performed; and
• You must submit an affidavit to Medicare expressing your decision to opt out of the program.

Medicare Contractor Opt-Out Affidavits

• CGS Administrators  (PDF)
• FCSO (First Coast Service Options): No official form. Opt-out providers who elect to order and refer services will be asked to provide the following information (unless it has been furnished within their written affidavit): National provider identifier; Confirmation if an Office of Inspector General (OIG) exclusion exists; Date of birth; Social Security number.
• NGS (National Government Services)  (PDF)
• Noridian  (PDF)
• Novitas  (PDF)
• Palmetto  (PDF)
• WPS Government Health Administrators  (PDF)

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What You Need to Know About Medicare Assignment

If you are one of the more than 63 million Americans enrolled in Medicare and are on the lookout for a new provider, you may wonder what your options are. A good place to start? Weighing the pros and cons of choosing an Original Medicare plan versus a Medicare Advantage plan—both of which have their upsides.

Let’s say you decide on an Original Medicare plan, which many U.S. doctors accept. In your research, however, you come across the term “Medicare assignment.” Cue the head-scratching. What exactly does that mean, and how might it affect your coverage costs?

What is Medicare Assignment?

It turns out that Medicare assignment   is a concept you need to understand before seeing a new doctor. First things first: Ask your doctor if they “accept assignment”—that exact phrasing—which means they have agreed to accept a Medicare-approved amount as full payment for any Medicare-covered service provided to you. If your doctor accepts assignment, that means they’ll send your whole medical bill to Medicare, and then Medicare pays 80% of the cost, while you are responsible for the remaining 20%.

A doctor who doesn’t accept assignment, however, could charge up to 15% more than the Medicare-approved amount for their services, depending on what state you live in, shouldering you with not only that additional cost but also your 20% share of the original cost. Additionally, the doctor is supposed to submit your claim to Medicare, but you may have to pay them on the day of service and then file a reimbursement claim from Medicare after the fact.

Worried that your doctor will not accept assignment? Luckily, 98% of U.S. physicians who accept Medicare patients also accept Medicare assignment, according to the U.S. Centers for Medicare & Medicaid Services (CMS). They are known as assignment providers, participating providers, or Medicare-enrolled providers.

It can be confusing. Here’s how to assess whether your provider accepts Medicare assignment, and what that means for your out-of-pocket costs:

The 3 Types of Original Medicare Providers

1. participating providers, or those who accept medicare assignment.

These providers have an agreement with Medicare to accept the Medicare-approved amount as full payment for their services. You don’t have to pay anything other than a copay or coinsurance (depending on your plan) at the time of your visit. Typically, Medicare pays 80% of the cost, while you are responsible for the remaining 20%, as long as you have met your deductible.

2. Non-participating providers

“Most providers accept Medicare, but a small percentage of doctors are known as non-participating providers,” explains Caitlin Donovan, senior director of public relations at the National Patient Advocate Foundation (NPAF) in Washington D.C. “These may be more expensive,” she adds. Also known as non-par providers, these physicians may accept Medicare patients and insurance, but they have not agreed to take assignment Medicare in all cases. That means they’re not held to the Medicare-approved amount as payment in full. As a reminder, a doctor who doesn’t accept assignment can charge up to 15% more than the Medicare-approved amount, depending on what part of the country you live in, and you will have to pay that additional amount plus your 20% share of the original cost.

What does that mean for you? Besides being charged more than the Medicare-approved amount, you might also be required to do some legwork to get reimbursed by Medicare.

• You may have to pay the entire bill at the time of service and wait to be reimbursed 80% of the Medicare-approved amount. In most cases, the provider will submit the claim for you. But sometimes, you’ll have to submit it yourself.
• Depending on the state you live in, the provider may also charge you as much as 15% more than the Medicare-approved amount. (In New York state, for example, that add-on charge is limited to 5%.) This is called a limiting charge—and the difference, called the balance bill, is your responsibility.

There are some non-par providers, however, who accept Medicare assignment   for certain services, on a case-by-case basis. Those may include any of the services—anything from hospital and hospice care to lab tests and surgery—available from any assignment-accepting doctor, with a key exception: If a non-par provider accepts assignment for a particular service, they cannot bill you more than the regular Medicare deductible and coinsurance amount for that specific treatment. Just as it’s important to confirm whether your doctor accepts assignment, it’s also important to confirm which services are included at assignment.

3. Opt-out providers

A small percentage of providers do not participate in Medicare at all. In 2020, for example, only 1% of all non-pediatric physicians nationwide opted out, and of that group, 42% were psychiatrists. “Some doctors opt out of providing Medicare coverage altogether,” notes Donovan.“In that case, the patient would pay privately.” If you were interested in seeing a physician who had opted out of Medicare, you would have to enter a private contract with that provider, and neither you nor the provider would be eligible for reimbursement from Medicare.

How do I know if my doctor accepts Medicare assignment?

The best way to find out whether your provider accepts Medicare assignment is simply to ask. First, confirm whether they are participating or non-participating—and if they are non-participating, ask whether they accept Medicare assignment for certain services.

Also, make sure to ask your provider exactly how they will be billing Medicare and what charges you might expect at the time of your visit so that you’re on the same page from the start.

Is seeing a non-participating provider who accepts Medicare assignment more expensive?

The short answer is yes. There are usually out-of-pocket costs after you’re reimbursed. But it may not cost as much as you think, and it may not be much more than if you see a participating provider. Still, it could be challenging if you’re on a fixed income.

For example, let’s say you’re seeing a physical therapist who accepts Medicare patients but not Medicare assignment. Medicare will pay $95 per visit to the provider; but your provider bills the service at $115. In most states, you’re responsible for a 15% limiting charge above $95. In this case, your bill would be 115% of $95, or $109.25.

Once you get your $95 reimbursement back from Medicare, your cost for the visit—the balance bill—would be $14.25 (plus any deductibles or copays) .

In some states, the maximum cap on the limiting charge is less than 15%. As mentioned earlier, New York state, for instance, allows only a 5% surcharge, which means that physical therapy appointment would cost you just $4.75 extra.

Bottom line: Medicare assignment providers and non-participating providers who agree to accept Medicare assignment are both viable options for patients. So if you want to see a particular provider, don’t rule them out just because they’re non-par.

While seeing a non-participating provider may still be affordable, ultimately, the biggest headache may be keeping track of claims and reimbursements, or simply setting aside the right amount of money to pay for your visit up front.

Before you schedule a visit, be sure to ask how much the service will cost. You can also estimate the payment amount based on Medicare-approved charges. A good place to start is this  out-of-pocket expense calculator  provided by the CMS.

What if I see a provider who opts out of Medicare altogether?

An opt-out provider will create a private contract with you, underscoring the terms of your agreement. But Medicare will not reimburse either of you for services.

Seeing a provider who does not accept Medicare will likely be more expensive. And your visits won’t count toward your deductible. But you may be able to work out paying reduced fees on a sliding scale for that provider’s services, all of which would be laid out in your contract.

Medicare Assignment: Understanding How It Works

Medicare assignment is a term used to describe how a healthcare provider agrees to accept the Medicare-approved amount. Depending on how you get your Medicare coverage, it could be essential to understand what it means and how it can affect you.

What is Medicare assignment?

Medicare sets a fixed cost to pay for every benefit they cover. This amount is called Medicare assignment.

You have the largest healthcare provider network with over 800,000 providers nationwide on Original Medicare . You can see any doctor nationwide that accepts Medicare.

Understanding the differences between your cost and the difference between accepting Medicare and accepting Medicare assignment could be worth thousands of dollars.

Doctors that accept Medicare

Your healthcare provider can fall into one of three categories:

Medicare participating provider and Medicare assignment

Medicare participating providers not accepting medicare assignment, medicare non-participating provider.

More than 97% of healthcare providers nationwide accept Medicare. Because of this, you can see almost any provider throughout the United States without needing referrals.

Let’s discuss the three categories the healthcare providers fall into.

Participating providers are doctors or healthcare providers who accept assignment. This means they will never charge more than the Medicare-approved amount.

Some non-participating providers accept Medicare but not Medicare assignment. This means you can see them the same way a provider accepts assignment.

You need to understand that since they don’t take the assigned amount, they can charge up to 15% more than the Medicare-approved amount.

Since Medicare will only pay the Medicare-approved amount, you’ll be responsible for these charges. The 15% overcharge is called an excess charge. A few states don’t allow or limit the amount or services of the excess charges. Only about 5% of providers charge excess charges.

Opt-out providers don’t accept Original Medicare, and these healthcare providers are in the minority in the United States. If healthcare providers don’t accept Medicare, they won’t be paid by Medicare.

This means choosing to see a provider that doesn’t accept Medicare will leave you responsible for 100% of what they charge you. These providers may be in-network for a Medicare Advantage plan in some cases.

Avoiding excess charges

Excess charges could be large or small depending on the service and the Medicare-approved amount. Avoiding these is easy. The simplest way is to ask your provider if they accept assignment before service.

If they say yes, they don’t issue excess charges. Or, on Medicare.gov , a provider search tool will allow you to look up your healthcare provider and show if they accept Medicare assignment or not.

Medicare Supplement and Medicare assignment

Medigap plans are additional insurance that helps cover your Medicare cost-share . If you are on specific plans, they’ll pay any extra costs from healthcare providers that accept Medicare but not Medicare assigned amount. Most Medicare Supplement plans don’t cover the excess charges.

The top three Medicare Supplement plans cover excess charges if you use a provider that accepts Medicare but not Medicare assignment.

Medicare Advantage and Medicare assignment

Medicare assignment does not affect Medicare Advantage plans since Medicare Advantage is just another way to receive your Medicare benefits. Since your Medicare Advantage plan handles your healthcare benefits, they set the terms.

Most Medicare Advantage plans require you to use network providers. If you go out of the network, you may pay more. If you’re on an HMO, you’d be responsible for the entire charge of the provider not being in the network.

Do all doctors accept Medicare Supplement plans?

All doctors that accept Original Medicare accept Medicare Supplement plans. Some doctors don’t accept Medicare. In this case, those doctors won’t accept Medicare Supplements.

Where can I find doctors who accept Medicare assignment?

Medicare has a physician finder tool that will show if a healthcare provider participates in Medicare and accepts Medicare assignments. Most doctors nationwide do accept assignment and therefore don’t charge the Part B excess charges.

Why do some doctors not accept Medicare?

Some doctors are called concierge doctors. These doctors don’t accept any insurance and require cash payments.

What is a Medicare assignment?

Accepting Medicare assignment means that the healthcare provider has agreed only to charge the approved amount for procedures and services.

What does it mean if a doctor does not accept Medicare assignment?

The doctor can change more than the Medicare-approved amount for procedures and services. You could be responsible for up to a 15% excess charge.

How many doctors accept Medicare assignment?

About 97% of doctors agree to accept assignment nationwide.

Is accepting Medicare the same as accepting Medicare assignment?

No. If a doctor accepts Medicare and accepts Medicare assigned amount, they’ll take what Medicare approves as payment in full.

If they accept Medicare but not Medicare assignment, they can charge an excess charge of up to 15% above the Medicare-approved amount. You could be responsible for this excess charge.

What is the Medicare-approved amount?

The Medicare-approved amount is Medicare’s charge as the maximum for any given medical service or procedure. Medicare has set forth an approved amount for every covered item or service.

Can doctors balance bill patients?

Yes, if that doctor is a Medicare participating provider not accepting Medicare assigned amount. The provider may bill up to 15% more than the Medicare-approved amount.

What happens if a doctor does not accept Medicare?

Doctors that don’t accept Medicare will require you to pay their full cost when using their services. Since these providers are non-participating, Medicare will not pay or reimburse for any services rendered.

Get help avoiding Medicare Part B excess charges

Whether it’s Medicare assignment, or anything related to Medicare, we have licensed agents that specialize in this field standing by to assist.

Give us a call, or fill out our online request form . We are happy to help answer questions, review options, and guide you through the process.

Related Articles

• What are Medicare Part B Excess Charges?
• How to File a Medicare Reimbursement Claim?
• Medicare Defined Coinsurance: How it Works?
• Welcome to Medicare Visit
• Guide to the Medicare Program

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Medicare PAR vs Non-PAR: Reduce Hassle and Boost Cashflow

Choosing the wrong Medicare participation status for your provider can have significant financial consequences for your practice. Your choices are a Medicare Participating Provider (PAR) or a Medicare Non-Participating Provider (non-PAR). If you make the wrong choice, your allowable reimbursement can be limited, or you can end up unable to get paid by Medicare at all.

Setting up your participation status typically happens during Medicare enrollment, but should also be revisited during the revalidation process. By understanding the similarities and differences between Medicare PAR and non-PAR provider statuses you can reduce your hassle to get paid – and keep more of the money you receive.

There are a variety of reasons one participation may work better for you than another. The information below will help you make the right decision for your practice – starting with what each status means.

What is a Medicare Participating Provider?

Enrolling as a Medicare participating provider means that you are in-network with the plan. You may also see this listed as a PAR provider. PAR stands for participating, and as such, your practice has a contract with Medicare.

As part of your PAR provider contract, your practice agrees to take assignment on all Medicare claims . This means you must accept the amount that Medicare assigns for payment for the services you provide. Typically, Medicare-participating providers are reimbursed 80% of the Agency’s allowable fee (if the patient has met their annual deductible). The remaining 20% can either be billed directly to the patient or to their secondary insurance (if they have it).

If you bill the remaining 20% to the patient’s secondary insurance, as a Medicare participating provider that accepts assignment, you should get directly reimbursed. However, if you bill the patient, it can be more complicated. Accordingly, it is important to know whether your Medicare patients have secondary insurance so that you can collect the amount they’ll be responsible for upfront – to avoid the hassle of chasing the money later.

Importantly, as a PAR provider, you cannot bill patients for any amount over the set Medicare allowable fee. Doing so is considered “balanced billing,” and could get your practice into considerable trouble both legally and financially.

What is a Non-Participating Provider?

Selecting a non-PAR designation means that you’ll be considered an out-of-network, non-participating provider. Non-PAR stands for non-participating. You are enrolled in Medicare but are not under contract with the Agency, so you must agree to receive payment for the services you provide to Medicare patients differently than a Medicare participating provider.

Not being constrained by a Medicare contract allows you to choose whether to accept assignment. This means choosing whether you’ll be paid by Medicare or the patient. You can choose your assignment designation on a claim-by-claim basis or for each of the Medicare claims you submit. Only non-PAR providers have this option.

• Non-PAR Accepting Medicare Assignment: Choosing to accept assignment means that you agree to be reimbursed directly from Medicare. Hence, you are governed by the same rules as a PAR provider and can only bill according to the allowable amounts on the Medicare Fee Schedule. However, there are some differences. As a non-PAR provider accepting assignment, you are paid 5% less than a Medicare participating provider. Also, to collect the 20% that Medicare doesn’t cover, you must go directly to the patient versus being able to bill their secondary insurance. In many instances, the patient’s secondary payer will reimburse them for the covered amount. . Note: Although you can bill the patient for the 20% of your claim that Medicare does not typically cover, you are NOT allowed to bill the patient for the 5% that Medicare reduces your claim by.
• Non-PAR NOT Accepting Medicare Assignment: If you don’t want to accept assignment, this means that you’ll bill and get paid by the patient. For those providers that choose not to accept assignment, the federal government has a “limiting charge” amount set for the services you provide to its beneficiaries. This is the highest amount you are allowed to charge. Your fees can be calculated at no more than 115% of the total Medicare Fee Schedule allowable amount for non-PAR providers.

PAR vs. Non-Par: Which is Right for You?

When deciding which Medicare participation designation is right for your practice, it is essential that you break down how and what you’ll be paid by each option. Items you should consider include:

• Total Medicare potential reimbursement
• Total secondary potential reimbursement
• Patient co-payments and payment responsibilities
• Collection costs
• Percentage of assignment and non-assignment claims

Typically, non-PAR providers that do not accept assignment must collect the full limiting charge amount approximately 35% of the time for their revenues to equal those of a Medicare participating provider for the same services. The key is understanding the allowable payment amounts for each designation, and how you’ll receive your reimbursement.

There are certainly similarities between each type of Medicare participation status. For example, PAR and non-PAR accepting assignment means the Medicare Administrative Coordinator (MAC) pays your practice directly for the 80% covered amount.

However, there are significant differences between the two designations that are important to note as well. Besides giving PAR providers a 5% higher pay rate than non-PARs, CMS provides these additional incentives to PAR providers that can help them gain more patients and receive their cash more quickly:

• Senior citizen groups receive directories of PAR providers and individual patients may request them
• Claims are processed more quickly because MACs provide toll-free claims processing lines

Use the below chart to help you break down each Medicare participation status and decide which one is right for you:

You can change a provider’s Medicare PAR or non-PAR status at any time. However, participation decisions go into effect on January 1 st of the next year and must be made by December 31 st of the current year. They are binding for one year between January and December.

Medicare participation can be confusing if you’re not aware of the specifics surrounding PAR and Non-PAR designations and what each can mean to your practice’s cash flow. In addition to enrollment, the revalidation process – which occurs every five years in Medicare’s Provider Enrollment, Chain and Ownership System (PECOS) – also requires you to choose your participation status. Failure to revalidate can lead to deactivation from Medicare and the loss of reimbursement funds.

Healthcare Training Leader has a wide selection of online trainings on enrollment and credentialing that will help you easily enroll your providers in Medicare and other programs, get them successfully credentialed and revalidate them when necessary.

Note: Your providers can also opt out of Medicare entirely. You can learn more about this option in Medicare’s Providers Enrollment Guide.

Source: https://www.aafp.org/family-physician/practice-and-career/getting-paid/medicare-options.html

Live Webinar: You attend the training online at a specific date and time along with the expert presenter who will answer your questions.

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On-Demand Recording: Watch a recording of the live event anytime – as often and for as long as you’d like. Access the recording (including Q&A) online within 24 hours of the live training date and time. Simply log into your Healthcare Training Leader account.

Live + CD-ROM: You attend the training online at a specific date and time along with the expert presenter who will answer your questions. You’ll also be mailed a recording of the actual live event on CD-ROM.

Live + On Demand: You attend the training online at a specific date and time along with the expert presenter who will answer your questions. You’ll also have access to a recorded version of the training to access at your convenience.

Corporate Access: Select this option to receive online, on-demand access to your training across each of your locations. Setup will be initiated by our account team within 48 hours of your enrollment and can be utilized by your entire team.

You and your entire team, at all your locations, can attend as many live and view as many recorded trainings as you like for 12 months.

You and your team, in one single location, can attend as many live and view as many recorded trainings as you like for 12 months.

What Part B covers

Medicare Part B (Medical Insurance) helps cover 2 types of services:

• Medically necessary services: Services or supplies that meet accepted standards of medical practice to diagnose or treat your medical condition.
• Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage when treatment is likely to work best.

You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment . 

If you're in a Medicare Advantage Plan or other Medicare plan, your plan may have different rules. But your plan must give you at least the same coverage as Original Medicare.  

Part B covers things like:

• Ambulance services  
• Clinical research
• Durable medical equipment (DME)  
• Limited outpatient prescription drugs
• Mental health & substance use disorders
• Oxygen equipment & accessories  

IMPORTANT INSULIN BENEFIT!  If you use an insulin pump that's covered under Part B's durable medical equipment benefit, or you get your covered insulin through a Medicare Advantage Plan, your cost for a month's supply of Part B-covered insulin for your pump can't be more than $35. The Part B deductible won't apply. 

If you get a 3-month supply of Part B-covered insulin, your costs can't be more than $35 for each month's supply. This means you'll generally pay no more than $105 for a 3-month supply of covered insulin.

If you have Part B and Medicare Supplement Insurance (Medigap) that pays your Part B coinsurance, your Medigap plan should cover the $35 (or less) cost for insulin.

Next step: Understand what Part A covers   Take action: Find out if Medicare covers a test, item, or service you need  Learn more: Learn what Original Medicare doesn’t cover  

Milestone Scientific Announces Medicare Price Assignment for the CompuFlo® Epidural System in Texas, Pennsylvania, New Jersey, Maryland, Colorado, Oklahoma, Louisiana, Arkansas, Mississippi, New Mexico, District of Columbia, and Delaware

ROSELAND, N.J., July 23, 2024 (GLOBE NEWSWIRE) -- Milestone Scientific Inc. (NYSE: MLSS) , a leading developer of computerized drug delivery instruments that provide painless and precise injections, today announced that Novitas Solutions, Inc. (Novitas), a Jurisdictional Medicare Administrative Contractor (JMAC), has granted a Medicare Part B Physician payment rate for the Company’s CompuFlo® Epidural System under the American Medical Association’s (AMA) technology-specific Category III CPT® code CPT0777T (real-time pressure-sensing epidural guidance system when used in conjunction with a primary ESI procedure).

This new price assignment applies to two Medicare regions: Jurisdiction L (JL) and Jurisdiction H (JH). JL includes Delaware, District of Columbia, Maryland, New Jersey, and Pennsylvania. JH includes Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas.

The pricing assignment by Novitas represents a significant step forward in Milestone Scientific’s strategy to ensure broad coverage and appropriate payment for the CompuFlo® technology when deemed medically necessary and clinically appropriate for Medicare beneficiaries. This decision follows the recently announced Medicare Jurisdiction N (JN) pricing assignment in Florida by First Coast Service Options Inc. (FCSO), marking another milestone in the Company’s ongoing efforts to expand access to this advanced technology.

Arjan Haverhals, CEO and President of Milestone Scientific, commented, “Securing Medicare price assignment for the CompuFlo® Epidural System in these additional states is a testament to the clinical value and safety of our technology. This approval by Novitas significantly expands our addressable market and enhances our ability to provide patients with safer, more comfortable epidural procedures. We remain committed to pursuing reimbursement in other Medicare jurisdictions across the country and are confident in our strategic approach to gain nationwide coverage. We also look forward to leveraging this momentum into new international markets.”

An estimated 3.0 million epidural steroid injection (ESI) procedures are performed each year in these three jurisdictions (JL, JH, JN), which represent approximately one-third of the total ESI procedures for the treatment of chronic back pain in the United States. Additionally, it is believed Medicare accounts for up to 40% of the clinical practice volume, representing an initial addressable market of approximately $250 million among Medicare patients in these three jurisdictions.

The CompuFlo® Epidural System uses Milestone Scientific’s patented Dynamic Pressure Sensing® technology, which provides real-time feedback to ensure accurate needle placement during epidural procedures. This technology is designed to reduce the morbidity, pain, and discomfort associated with traditional epidural techniques, enhancing patient safety and outcomes.

Medicare reimbursement for the CompuFlo® Epidural System is expected to provide several key benefits:

• Increased Accessibility : Medicare reimbursement will make this advanced technology more accessible to a broader patient population, ensuring more Medicare beneficiaries can benefit from safer and more comfortable epidural procedures.
• Enhanced Patient Outcomes : By ensuring accurate needle placement, the CompuFlo® technology reduces the risk of complications, leading to better patient outcomes and higher satisfaction.
• Support for Healthcare Providers : The availability of reimbursement will support healthcare providers by allowing them to offer advanced pain management solutions without financial barriers, improving the overall quality of care.

Milestone Scientific is dedicated to expanding its reimbursement strategy across additional JMAC regions, with the goal of establishing the CompuFlo® technology as a standard of care in epidural procedures nationwide.

About Milestone Scientific Inc. Milestone Scientific Inc. (MLSS) is a technology-focused medical research and development company that patents, designs and develops innovative injection technologies and instruments for medical and dental applications. Milestone Scientific’s computer-controlled systems are designed to make injections precise and efficient, as well as increase overall patient comfort and safety. The Company’s proprietary DPS Dynamic Pressure Sensing Technology ® provides a platform to advance the development of next-generation devices, regulating flow rate and monitoring pressure from the tip of the needle, through platform extensions involving subcutaneous drug delivery of local anesthetic. To learn more, view the MLSS brand video or visit milestonescientific.com .

Safe Harbor Statement

This press release contains forward-looking statements regarding the timing and financial impact of Milestone’s ability to implement its business plan, expected revenues, timing of regulatory approvals and future success. These statements involve a number of risks and uncertainties and are based on assumptions involving judgments with respect to future economic, competitive and market conditions, future business decisions and regulatory developments, all of which are difficult or impossible to predict accurately and many of which are beyond Milestone’s control. Some of the important factors that could cause actual results to differ materially from those indicated by the forward-looking statements are general economic conditions, failure to achieve expected revenue growth, changes in our operating expenses, adverse patent rulings, FDA or legal developments, competitive pressures, changes in customer and market requirements and standards, and the risk factors detailed from time to time in Milestone’s periodic filings with the Securities and Exchange Commission, including without limitation, Milestone’s Annual Report for the year ended December 31, 2022 . The forward-looking statements in this press release are based upon management’s reasonable belief as of the date hereof. Milestone undertakes no obligation to revise or update publicly any forward-looking statements for any reason.

Contact: Crescendo Communications, LLC Email: [email protected] Tel: 212-671-1020