As provided in §4507 of the Balanced Budget Act of 1997, a "private contract" is a contract between a Medicare beneficiary and a physician or other practitioner who has "opted out" of Medicare for two years for all covered items and services he or she furnishes to Medicare beneficiaries. In a private contract, the Medicare beneficiary agrees to give up Medicare payment for services furnished by the physician or practitioner and to pay the physician or practitioner without regard to any limits that would otherwise apply to what the physician or practitioner could charge.
The Opt-Out Listing is updated on a quarterly basis. For a list of all physicians and practitioners that are currently opted out of Medicare, please review the CMS Opt-Out Affidavit listing. The listing can be searched in a number of ways and is easy to use.
For additional information on Opting Out , please visit the CMS Opt Out of Medicare Enrollment page. If you are an opt-out provider and cannot locate your information, please call us at 1-877-235-8073.
Note: Effective March 2018, the local opt-out listings have been removed from our website. We encourage you to use the CMS interactive opt-out listings to build reports and search for providers who have opted out of the Medicare program.
To opt-out, practitioners must submit an Opt Out Affidavit. 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, practitioners are not required to file renewal affidavits every two years. If electing not to extend their opt out status at the end of a two year opt out period, they may cancel by notifying all Medicare contractors with which they filed an affidavit, in writing, at least 30 days prior to the start date of the next two year opt out period. For more information on opting out/private contracting, please review Chapter 9 - Private Contracting (Opt Out) of the Enrollment Reference Guide or the CMS Quick Reference Chart.
An example affidavit is provided for consideration. The terms of the affidavit should be carefully reviewed for compliance by all physician/practitioners who are considering opting out of Medicare. The affidavit may be mailed or faxed to us. Opting out using the online methods is not available.
Our mailing address and fax number for customers in Delaware and the District of Columbia, Maryland, New Jersey, Pennsylvania is:
Provider Enrollment Services
PO Box 3157
Mechanicsburg, PA 17055-1836
Fax Number: 717-728-8759