US · guidance
CMS Pub. 100-02, ch. 15, § 40.27
System Identification
The Medicare contractor must ensure that its system can automatically identify claims that include services
furnished by providers or practitioners who have opted out of Medicare. It must not make payment to any
opt-out physician/practitioner for items or services furnished on or after the effective date of the physician’s
or practitioner’s opt out affidavit unless there are emergency or urgent care situations involved. In an
emergency or urgent care situation, payment can be made for services furnished to a Medicare beneficiary if
the beneficiary has no contract with the opt-out physician/practitioner. See the following section for related
instructions.
History
(Rev. 160, Issued: 10-26-12, Effective: 01-28-13, Implementation: 01-28-13)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
6df1ec712df680b871af1abc18c45fa7c29533fe93fce61e9e5f6a5aab5aaf90
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