42 C.F.R. § 405.455

Application to Medicare Advantage contracts.

Last amended: 2017Year: 2026Length: 124 wordsSubsections: 3Official source

Cite as 42 C.F.R. § 405.455 (2026)

An organization that has a contract with CMS to provide one or more Medicare Advantage (M + C) plans to beneficiaries (part 422 of this chapter): (a) Must acquire and maintain information from Medicare carriers on physicians and practitioners who have opted-out of Medicare. (b) Must make no payment directly or indirectly for Medicare covered services furnished to a Medicare beneficiary by a physician or practitioner who has opted-out of Medicare. (c) May make payment to a physician or practitioner who furnishes emergency or urgent care services to a beneficiary who has not previously entered into a private contract with the physician or practitioner in accordance with § 405.440. [63 FR 58901, Nov. 2, 1998, as amended at 79 FR 68001, Nov. 13, 2014]
Cross-references to the CFR
405.440.
42 C.F.R. § 405.455: Application to Medicare Advantage contracts. | Justis AI