[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR405.410]



[Page 101-102]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 405_FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED--Table of 

Contents

 

                       Subpart D_Private Contracts

 

Sec. 405.410  Conditions for properly opting-out of Medicare.



    The following conditions must be met for a physician or practitioner 

to properly opt-out of Medicare:

    (a) Each private contract between a physician or a practitioner and 

a Medicare beneficiary that is entered into prior to the submission of 

the affidavit described in paragraph (b) of this section must meet the 

specifications of Sec. 405.415.

    (b) The physician or practitioner must submit an affidavit that 

meets the specifications of Sec. 405.420 to each Medicare carrier with 

which he or she would file claims absent completion of opt-out.

    (c) A nonparticipating physician or a practitioner may opt-out of 

Medicare at any time in accordance with the following:

    (1) The 2-year opt-out period begins the date the affidavit meeting 

the requirements of Sec. 405.420 is signed, provided the affidavit is 

filed within 10 days after he or she signs his or her first private 

contract with a Medicare beneficiary.

    (2) If the physician or practitioner does not timely file any 

required affidavit, the 2-year opt-out period begins when the last such 

affidavit is filed. Any private contract entered into before the last 

required affidavit is filed becomes effective upon the filing of the 

last required affidavit and the furnishing of any items or services to a 

Medicare beneficiary under such contract before the last required 

affidavit is filed is subject to standard Medicare rules.

    (d) A participating physician may properly opt-out of Medicare at 

the beginning of any calendar quarter, provided that the affidavit 

described in Sec. 405.420 is submitted to the participating physician's 

Medicare carriers at least 30 days before the beginning of the selected 

calendar quarter. A private contract entered into before the beginning 

of the selected calendar quarter becomes effective at the beginning of 

the selected calendar quarter and the furnishing of any items or 

services to a Medicare beneficiary



[[Page 102]]



under such contract before the beginning of the selected calendar 

quarter is subject to standard Medicare rules.