GJ - JE Part B
"Opt out" physician or practitioner emergency or urgent services
In an emergency or urgent care situation, a physician/practitioner who opts out may treat a Medicare beneficiary with whom he/she does not have a private contract and bill for such treatment. In such a situation, the provider may not charge the beneficiary more than what a nonparticipating physician/practitioner would be permitted to charge and must submit a claim to Medicare on the beneficiary's behalf.
- Example - Physician was called in to see a patient in the emergency room whom he has not seen before and no contract was signed
Claim Coding Example
- Opt out physician to append for non-emergent services that have a private contract with patients.
- CMS Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 40.5
Last Updated Mon, 31 Oct 2022 18:57:29 +0000