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Jurisdiction 1 Part B
Opt Out of Medicare Provider Enrollment: Instructions

Private Contract
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.

You can access complete lists of health professionals that have chosen to ‘opt out’ of the Medicare program in the Opt Out page of our
Provider Enrollment section.

To opt out of Medicare:
Participating physicians must first terminate their Medicare Part B participation agreement.

Participating providers are only permitted to opt out at the beginning of each calendar quarter. Therfore, a provider must submit a valid Affidavit Form (PDF, 291 KB) at least 30 days before the first day of any quarter (January, April, July or October).

  • Non-participating physicians and practitioners, however, may opt out at any time
  • Certain health care provider categories, however, cannot opt out of Medicare. These include chiropractors and physical therapists in independent practices and occupational therapists in independent practices.

The Opt Out contract is for a two-year period from the date the physician or practitioner files and signs an affidavit notifying Medicare that he or she has opted out of Medicare. After the two-year period is over, the physician or practitioner could elect to return to Medicare or to 'opt out' again.

Please send your opt out request to:
J1 MAC - Palmetto GBA
Provider Enrollment
P.O. Box 1508
Augusta, GA 30903-1508

 

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last updated on 07/10/2009
ver 1.0.5.5