Private Contracting Rules When Medicare is the Secondary Payer

40.25 - Private Contracting Rules When Medicare is the Secondary Payer (Rev. 1, 10-01-03) B3-3044.25 The opt-out physician/practitioner must have a private contract with a Medicare beneficiary for all Medicare-covered services (see §40.7), notwithstanding that Medicare would be the secondary payer in a given situation. No Medicare primary or secondary payments will be made for items and services furnished by a physician/practitioner under the private contract.