The following physicians who are legally authorized to practice medicine, surgery, dentistry, podiatry, or optometry by the state in which such function or action is performed may opt-out of Medicare and privately contract with beneficiaries for the purpose of furnishing items or services that would otherwise be covered:
Doctors of medicine;
Doctors of osteopathy;
Doctors of dental surgery or dental medicine;
Doctors of podiatric medicine;
and Doctors of optometry.
AAs, CNMs, CNSs, CPs, CRNAs, CSWs, and PAs who are legally authorized to practice by the State and otherwise meet Medicare requirements may also opt-out of Medicare and privately contract with beneficiaries for the purpose of furnishing items or services that would otherwise be covered.
The opt-out period is for two years unless it is terminated early or the physician or practitioner fails to maintain opt-out. Opt-outs may be renewed for subsequent two-year periods. The physician or practitioner must opt-out of Medicare for all beneficiaries and all items or services, with the exception of emergency or urgent care situations, in which case the physician or practitioner may treat a beneficiary with whom he or she does not have a private contract and bill Medicare for the treatment. Claims for emergency or urgent care require modifier GJ, "OPT-OUT physician or practitioner emergency or urgent service.”
Medicare will make payment for covered medically necessary items or services that are ordered by a physician or practitioner who has opted-out of Medicare if:
He or she has acquired a provider identifier; and
The items or services are not furnished by a physician or practitioner who has also opted-out of Medicare.
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