StacksVerified U.S. regulatory reference

42 CFR §405.455

Verified against eCFR.gov as of June 20, 2026View official text on eCFR.gov ↗
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):
  1. (a)Must acquire and maintain information from Medicare carriers on physicians and practitioners who have opted-out of Medicare.
  2. (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.
  3. (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.