Opt Out and Private Contracting

Opt out does not require a physician or practitioner to initially enroll with Medicare or complete a CMS-855I application.

Opting out of Medicare allows a physician or practitioner to render services to Medicare-enrolled beneficiaries under a private contract.

Neither the physician or practitioner, nor the beneficiary submits the bill to Medicare for services rendered.

The beneficiary pays the physician or practitioner out-of-pocket and neither is reimbursed by Medicare.

A private contract is a signed agreement between the physician or practitioner and the beneficiary that states, that neither one can receive payment from Medicare for the services that were performed.

Related Content

• Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 40

Reviewed 6/18/2024