---
kind: "section"
citation: "42 C.F.R. § 405.430"
title: "42"
number: "405.430"
heading: "Failure to properly opt-out."
url: "https://uscodex.org/cfr/42/405.430"
---

# §405.430. Failure to properly opt-out.

- (a) **A physician or practitioner fails to properly opt-out if—**
  - (1) Any private contract between the physician or practitioner and a Medicare beneficiary, that was entered into before the affidavit described in [§ 405.420](/cfr/42/405.420.md) was filed, does not meet the specifications of [§ 405.415](/cfr/42/405.415.md); or
  - (2) He or she fails to submit the affidavit(s) in accordance with [§ 405.420](/cfr/42/405.420.md).
- (b) If a physician or practitioner fails to properly opt-out in accordance with [paragraph (a)](#a) of this section, the following results obtain:
  - (1) The physician's or practitioner's attempt to opt-out of Medicare is nullified, and all of the private contracts between the physician or practitioner and Medicare beneficiaries for the two-year period covered by the attempted opt-out are deemed null and void.
  - (2) The physician or practitioner must submit claims to Medicare for all Medicare-covered items and services furnished to Medicare beneficiaries, including the items and services furnished under the nullified contracts. A nonparticipating physician is subject to the limiting charge provisions of [§ 414.48](/cfr/42/414.48.md) of this chapter. A participating physician is subject to the limitations on charges of the participation agreement he or she signed.
  - (3) The practitioner may not reassign any claim except as provided in [§ 424.80](/cfr/42/424.80.md) of this chapter.
  - (4) The practitioner may neither bill nor collect an amount from the beneficiary except for applicable deductible and coinsurance amounts.
  - (5) The physician or practitioner may make another attempt to properly opt-out at any time.

## Notes

### Authority

Authority: Secs. 1102, 1802, and 1871 of the Social Security Act (42 U.S.C. 1302, 1395a, and 1395hh).

### Source

Source: 63 FR 58901, Nov. 2, 1998, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 263a, 405(a), 1302, 1320b-12, 1395x, 1395y(a), 1395ff, 1395hh, 1395kk, 1395rr, and 1395ww(k).