Updated 2026-07-30
A provider who files an opt-out affidavit leaves Medicare and contracts privately with patients: Medicare does not pay for their services during the opt-out period, apart from emergency and urgent care furnished under the rules in 42 CFR 405.440. CMS publishes opt-out affidavits in a public file with effective and end dates — and affidavits signed on or after June 16, 2015 renew automatically every two years unless the provider cancels. PECOS Lookup checks any NPI against the loaded file and shows the file's vintage on the result.
Opting out is a formal affidavit, not a lapse or a removal. The provider chooses to leave Medicare and bill patients under private contracts instead. During the opt-out period, Medicare does not pay for that provider's services apart from emergency and urgent care under 42 CFR 405.440 — the patient pays under the private contract they signed.
Opt-out is also different from never having enrolled, from a deactivated enrollment, and from OIG exclusion. Opt-outs and exclusions appear as affirmative rows in their own public files, which this tool shows with source and vintage; never-enrolled and deactivated states do not have public files of their own — they can only look like absence from the enrollment file, which is why absence is never treated as a finding here.
Results here show the file's vintage — the CMS publication the row came from — plus the time it was checked. An opt-out that began or ended after that vintage will not appear until CMS publishes the next file.
Run the provider's 10-digit NPI through the lookup on the home page. If an exact-NPI row exists in the loaded opt-out file, the result shows the affidavit's effective and end dates with the file's vintage. The same lookup shows the public enrollment signal side by side — useful because opted-out and never-enrolled look identical to a patient but mean different things. See NPI vs PECOS for that distinction.
An NPI not found in the loaded opt-out file is not proof the provider participates in Medicare — absence in a public file is never a negative finding. Confirm anything consequential with CMS or the provider directly.
Often yes. The public file carries an eligible-to-order-and-refer flag for each opt-out row, and the lookup shows it — many opted-out providers keep ordering and referring ability while their own services go unpaid by Medicare.
Affidavits signed before June 16, 2015 expired after two years unless renewed. Affidavits signed on or after that date renew automatically every two years unless the provider affirmatively cancels — so a past end date in the public file is not proof the opt-out ended. Verify current status with CMS or the provider before making a payment decision.
Check any NPI against the public opt-out file free — exact-NPI matches with effective and end dates and the file's vintage