Opting out of Medicare: what CMS says, and why therapists are not on the list
Some physicians and practitioners may opt out of Medicare by filing an opt-out affidavit and signing private contracts with their Medicare patients. CMS’s enrollment page lists occupational therapists, physical therapists, qualified audiologists, and qualified speech language pathologists among providers not eligible to opt out. Chapter 15 of the Medicare Benefit Policy Manual says physical therapists and occupational therapists in independent practice cannot opt out. This page quotes CMS and eCFR; it does not tell anyone whether to enroll.
Quoted from official pages checked November 10, 2026. Confirm current requirements, fees, and dates on those sites. This page is not legal advice and does not guarantee eligibility, certification, or licensure.
Sources read on November 10, 2026: CMS’s Manage Your Enrollment page, section ‘Opt Out of Medicare’ (page last modified 03/04/2026); the Medicare Benefit Policy Manual, Chapter 15 (PDF), sections 40 through 40.7; and 42 CFR Part 405, Subpart D on eCFR (up to date as of 11/06/2026). No fees or charge limits are copied. Enrollment itself is on Medicare enrollment.
What opting out means, in CMS’s words
CMS’s enrollment page states: “Physicians and practitioners who see Medicare patients but don’t want to enroll in the Medicare program must opt-out of Medicare. This means you and your Medicare patients can’t bill Medicare for services and your Medicare patients pay out of pocket.” It adds: “If you don’t see Medicare patients, you don’t have to enroll in or opt-out of Medicare.”
To opt out, CMS says you must “Be an eligible type or specialty.”, “Submit an opt-out affidavit to Medicare.”, and “Enter into a private contract with each of your Medicare patients.” It says you can’t “Choose to opt-out of Medicare for some Medicare patients and services but not for others”. And: “You can’t enroll in Medicare and opt-out of Medicare. The only exception is to enroll to get paid for emergency or urgent care services.”
On timing, the page states: “If you’re currently opted out, your opt-out status will automatically renew every 2 years.” Chapter 15, section 40.2, states: “Valid opt-out affidavits signed on or after June 16, 2015, will automatically renew every 2 years.”
Who may opt out
CMS’s page lists ‘Providers Eligible to Opt Out’: doctors of medicine, osteopathy, dental surgery or dental medicine, podiatric medicine, and optometry; physician assistants; nurse practitioners; clinical nurse specialists; certified registered nurse anesthetists; certified nurse midwives; clinical psychologists; clinical social workers; registered dieticians and nutrition professionals; marriage and family therapists; and mental health counselors.
42 CFR 405.400 defines practitioner as “a physician assistant, nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, certified nurse midwife, clinical psychologist, clinical social worker, marriage and family therapist, mental health counselor, registered dietitian or nutrition professional, who is currently legally authorized to practice in that capacity by each State in which he or she furnishes services to patients or clients.”
Chapter 15, section 40.4 (Rev. 62), states: “Only physicians and practitioners that are listed in §40.4 may opt out.” Its own list of practitioners ends with “Registered dietitian; or” “Nutrition Professional” and does not include marriage and family therapists or mental health counselors, which the CMS page and eCFR do list. The lists are left side by side.
Occupational therapists, physical therapists, and speech-language pathologists
CMS’s page lists ‘Providers NOT Eligible to Opt Out’: anesthesiology assistants, chiropractors, “Occupational therapists”, “Physical therapists”, “Qualified audiologists”, and “Qualified speech language pathologists”.
Chapter 15, section 40.4, states: “Physical therapists in independent practice and occupational therapists in independent practice cannot opt out because they are not within the opt out law’s definition of either a ‘physician’ or ‘practitioner’.” That section does not mention speech-language pathologists; the CMS page does. Neither source mentions therapy assistants (OTAs, PTAs, SLPAs).
Medicare Advantage and opted-out practitioners
CMS’s page says Medicare Advantage plans “May not pay (directly or indirectly) for basic services provided to a Medicare enrollee by a physician or practitioner who filed a valid opt-out affidavit with Medicare.” Appeals in those plans are on Medicare Advantage appeals.
What this page does not do
It does not say whether any therapist should enroll, does not copy charge limits or fees, and does not describe private-pay or cash-practice arrangements outside what CMS states. It is not legal, billing, or compliance advice. Confirm current rules with the agency or organization that publishes them, your employer, and your state board.