Renewal of Opt-Out Status

Current opt-out providers are automatically renewed every two years. Notification letters are typically sent approximately 90 days before the opt-out is due to renew. The letter advises that the opt-out will be renewed shortly.

Cancellation of Opt-Out Status

To end opt-out status and re-enroll in Medicare, the provider must submit a written cancellation request by mail. The request must be signed and dated. The Medicare Administrative Contractor (MAC) must receive the cancellation letter at least 30 calendar days before the opt-out period expires.

For example, if an opt‑out renews on July 1, the provider must take action to cancel no later than June 1. Canceling an opt-out does not automatically enroll the provider in Medicare.

If the cancellation request is received less than 30 calendar days before the opt-out expiration date, the provider remains opted out for another two-year cycle.

If the cancellation request is received more than 90 days prior to the opt-out expiration date, it will be returned to provider.

Opt-Out Affidavit Effective Dates

A signed and dated opt-out affidavit must be filed with each Medicare Administrative Contractor (MAC) that would otherwise have jurisdiction over the provider's Medicare claims. In general, the provider must file the affidavit no later than 10 days after entering the first private contract to which the affidavit applies.

The effective date of a Medicare opt-out varies depending on the provider's participation status as recorded in the Provider Enrollment, Chain, and Ownership System (PECOS). For non-participating providers, the opt-out period generally begins on the date the affidavit is signed and properly submitted according to CMS requirements. For participating providers, the opt-out becomes effective at the start of the next quarter (January 1, April 1, July 1, or October 1), provided the affidavit is submitted at least 30 days before that quarter begins. Because PECOS maintains the provider's participation status, it is important for providers to ensure their PECOS records are accurate, as discrepancies may affect the determination of the opt-out effective date. If there is any uncertainty, providers should contact their MAC to confirm how their current PECOS status will impact their opt-out timing.

If the provider does not timely file the opt-out affidavit(s), the initial opt-out period begins when the last required affidavit is filed. Any private contract entered into before the last required affidavit is filed becomes effective on the date the last required affidavit is filed, and items or services furnished before that date are subject to standard Medicare rules.

Example (participating providers): If the provider wants an opt-out effective date of July 1, the provider must file the affidavit at least 30 days before July 1. If the provider misses that deadline, the effective date is the next quarter the provider qualifies for.

The affidavit must include an original signature, and the signature date must be within 120 days of the date the MAC receives the affidavit.

How to Submit an Opt-Out Request

To opt out of Medicare, an eligible provider must submit a written opt-out affidavit to the Medicare Administrative Contractor (MAC).

Opt-Out Affidavit Requirements

Completing the Affidavit

A suggested opt-out affidavit template is available under the Enrollment Forms section of the Forms webpage. Providers may also create their own affidavit, as long as it includes all required elements and statements. Incomplete affidavits delay processing and may be rejected. The provider must sign and date the affidavit and must indicate whether they wish to order and refer services (for example, by checking "Yes" or "No" on the Noridian affidavit).

Required Affidavit Statements

Under 1802(b)(3)(B) and (D) of the Act and Medicare regulations, a valid affidavit must:

• Be in writing and be signed by the physician/practitioner;
• Contain the physician's or practitioner's full name, address, telephone number, NPI or billing number (if one has been assigned), or, if an NPI has not been assigned, the physician's or practitioner's tax identification number (TIN);
• State that, except for emergency or urgent care services (as specified in §40.28), during the opt-out period the physician/practitioner will provide services to Medicare beneficiaries only through private contracts that meet the criteria of §40.8 for services that, but for their provision under a private contract, would have been Medicare-covered services;
• State that the physician/practitioner will not submit a claim to Medicare for any service furnished to a Medicare beneficiary during the opt-out period, nor will the physician/practitioner permit any entity acting on the physician's/practitioner's behalf to submit a claim to Medicare for services furnished to a Medicare beneficiary, except as specified in §40.28;
• State that, during the opt-out period, the physician/practitioner understands that the physician/practitioner may receive no direct or indirect Medicare payment for services that the physician/practitioner furnishes to Medicare beneficiaries with whom the physician/practitioner has privately contracted, whether as an individual, an employee of an organization, a partner in a partnership, under a reassignment of benefits, or as payment for a service furnished to a Medicare beneficiary under a Medicare Advantage plan;
• State that a physician/practitioner who opts-out of Medicare acknowledges that, during the opt-out period, the physician's/practitioner's services are not covered under Medicare and that no Medicare payment may be made to any entity for the physician's/practitioner's services, directly or on a capitated basis;
• State on acknowledgment by the physician/practitioner to the effect that, during the opt-out period, the physician/practitioner agrees to be bound by the terms of both the affidavit and the private contracts that the physician/practitioner has entered into;
• Acknowledge that the physician/practitioner recognizes that the terms of the affidavit apply to all Medicare-covered items and services furnished to Medicare beneficiaries by the physician/practitioner during the opt-out period (except for emergency or urgent care services furnished to the beneficiaries with whom the physician/practitioner has not previously privately contracted) without regard to any payment arrangements the physician/practitioner may make;
• With respect to a physician/practitioner who has signed a Part B participation agreement, acknowledge that such agreement terminates on the effective date of the affidavit;
• Acknowledge that the physician/practitioner understands that a beneficiary who has not entered into a private contract and who requires emergency or urgent care services may not be asked to enter a private contract with respect to receiving such services and that the rules of §40.28 apply if the physician/practitioner furnishes such services;
• Identify the physician/practitioner sufficiently so that the Medicare contractor can ensure that no payment is made to the physician/practitioner during the opt-out period; and
• Be filed with all MACs who have jurisdiction over claims the physician/practitioner would otherwise file with Medicare, and the initial 2-year opt-out period will begin the date the affidavit meeting the requirements of 42 C.F.R §405.420 is signed, provided the affidavit is filed within 10 days after the physician/practitioner signs his or her first private contract with a Medicare beneficiary.

Ordering, Certifying, and Prescribing Status

A provider who has opted out of Medicare may be eligible to order, certify, and prescribe by supplying the required Social Security Number, date of birth, and NPI on the opt-out affidavit. If any required element is missing, the provider will not be approved to order, certify, and/or prescribe.

If the provider wishes to order and refer services, this must be indicated on the affidavit (for example, by checking "Yes" or "No" on the affidavit template or including an equivalent statement on a self-created affidavit). If "No" is selected, the provider will not be set up to order and refer services. For additional requirements related to Part D drugs, refer to CMS Internet-Only Manual (IOM) Publication 100-08, Medicare Integrity Manual, Chapter 10.

Changes After Opt-Out (Address Updates)

To update an address, the provider must mail a new opt-out affidavit that includes the updated address. Include a cover sheet stating that the submission is an address update.

Where to Send the Affidavit

The signed affidavit must be mailed to the appropriate Medicare Administrative Contractor (MAC). Mailing addresses vary by state and are available on the Mailing Addresses webpage. Certified or courier mailing is recommended for tracking purposes.

Processing Timeframe and Development Requests

If the MAC needs missing or additional information, the MAC will send one development request and apply the timelines below.

Opt-out applications are typically processed within 60 days of receipt.

• If information is missing, the MAC will send one letter or email requesting the missing information.
• The provider must submit the requested information within 30 days.
• If the MAC does not receive the requested information within 30 days, the MAC will reject the opt-out request and the provider must resubmit.