Resource Library

Dentists who opt out of Medicare must provide their Medicare-eligible patients appropriate notice, via a private contract, before providing them with Medicare covered services in order for the contract to apply. This document is a sample contract.

This sample affidavit from the ADA can be used by providers who would like to opt out of Medicare and return it to CGS Administrators, LLC, Provider Enrollment Department, P.O. Box 20017, Nashville, TN 37202-0013. Dentists should provide CGS with additional information, e.g. Social Security Number, if requested after submitting this affidavit.