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Last Modified: 6/28/2018 Location: FL, PR, USVI Business: Part B

Opt-out providers wishing to order/refer FAQ

Q: Does a physician or non-physician practitioner who has chosen to opt-out of the Medicare program still need to enroll to order/refer items or services for Medicare beneficiaries?
A: A provider that has opted out of the Medicare program is not required to complete a separate application to order or refer items/services for beneficiaries to other Medicare providers. However, the opt-out provider must meet the following qualifications:
His or her opt-out information must be current.
Note: For more information regarding opt-out requirements, please click here.
He or she must be of a specialty type eligible to order/refer items or services for Medicare beneficiaries.
Physicians (doctor of medicine or osteopathy, doctor of dental medicine, doctor of dental surgery, doctor of podiatric medicine, doctor of optometry, optometrists may only order and certify DMEPOS products/services and laboratory and X-Ray services payable under Medicare Part B)
Physician Assistants
Clinical Nurse Specialists
Clinical Psychologists
Interns, Residents, and Fellows
Certified Nurse Midwives
Clinical Social Workers
Source: Centers for Medicare & Medicaid Services Special Edition (SE) 1311 external pdf file and SE1305 external pdf file
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