Headline numbers
- Opt-out records
- 57,780
- 57,015 distinct providers
- Behavioral health share
- 61.0%
- 35,238 records in five specialties
- Largest state
- California
- 11,000 records, 19.0%
- Effective in 2024
- 15,737
- 10,721 therapists and counselors
- Eligible to order and refer
- 52.4%
- 30,296 records
- Specialties in the file
- 117
Opt-outs by specialty
Five behavioral health specialties make up 61.0% of the file: clinical psychologists (7,899), mental health counselors (7,860), clinical social workers (7,580), marriage and family therapists (6,882), psychiatrists (5,017). Dentists and oral surgeons follow with 8,451 records, then family practice (2,901), nurse practitioner (2,889), internal medicine (1,767).
| Specialty | Records | Share |
|---|---|---|
| Clinical Psychologist | 7,899 | 13.7% |
| Mental Health Counselor | 7,860 | 13.6% |
| Clinical Social Worker | 7,580 | 13.1% |
| Marriage And Family Therapist | 6,882 | 11.9% |
| Psychiatry | 5,017 | 8.7% |
| Dentist | 4,461 | 7.7% |
| Oral Surgery | 3,990 | 6.9% |
| Family Practice | 2,901 | 5.0% |
| Nurse Practitioner | 2,889 | 5.0% |
| Internal Medicine | 1,767 | 3.1% |
The other 107 specialties
| Specialty | Records | Share |
|---|---|---|
| Obstetrics/Gynecology | 780 | 1.3% |
| Physician Assistant | 699 | 1.2% |
| Plastic And Reconstructive Surgery | 431 | 0.7% |
| Maxillofacial Surgery | 419 | 0.7% |
| Orthopedic Surgery | 378 | 0.7% |
| Registered Dietitian Or Nutrition Professional | 315 | 0.5% |
| General Practice | 292 | 0.5% |
| Dermatology | 268 | 0.5% |
| Pediatric Medicine | 259 | 0.4% |
| Physical Medicine And Rehabilitation | 208 | 0.4% |
| Optometry | 190 | 0.3% |
| Osteopathic Manipulative Medicine | 185 | 0.3% |
| Neurology | 181 | 0.3% |
| Endocrinology | 140 | 0.2% |
| Podiatry | 126 | 0.2% |
| Emergency Medicine | 97 | 0.2% |
| Anesthesiology | 89 | 0.2% |
| Otolaryngology | 89 | 0.2% |
| General Surgery | 88 | 0.2% |
| Preventive Medicine | 88 | 0.2% |
| Ophthalmology | 86 | 0.1% |
| Cardiovascular Disease (Cardiology) | 80 | 0.1% |
| Neurosurgery | 76 | 0.1% |
| Periodontics | 74 | 0.1% |
| Certified Nurse Midwife (Cnm) | 65 | 0.1% |
| Allergy/Immunology | 64 | 0.1% |
| Rheumatology | 61 | 0.1% |
| Urology | 61 | 0.1% |
| Pain Management | 59 | 0.1% |
| Certified Clinical Nurse Specialist (Cns) | 55 | 0.1% |
| Gastroenterology | 53 | 0.1% |
| Undefined Non-Physician Type (Specify) | 49 | 0.1% |
| Diagnostic Radiology | 33 | 0.1% |
| Prosthodontics | 26 | 0.0% |
| Endodontics | 25 | 0.0% |
| Pulmonary Disease | 23 | 0.0% |
| Sports Medicine | 23 | 0.0% |
| Addiction Medicine | 22 | 0.0% |
| Interventional Pain Management | 22 | 0.0% |
| Orthodontics | 18 | 0.0% |
| Pathology | 15 | 0.0% |
| Geriatric Medicine | 14 | 0.0% |
| Sleep Medicine | 13 | 0.0% |
| Hematology/Oncology | 9 | 0.0% |
| Pediatric Dentistry | 9 | 0.0% |
| Vascular Surgery | 9 | 0.0% |
| Neuropsychiatry | 8 | 0.0% |
| Gynecological Oncology | 7 | 0.0% |
| Infectious Disease | 7 | 0.0% |
| Nephrology | 7 | 0.0% |
| Hospice/Palliative Care | 6 | 0.0% |
| Interventional Radiology | 6 | 0.0% |
| Orthodontics And Dentofacial Orthopedics | 6 | 0.0% |
| Pediatric Dentist | 6 | 0.0% |
| Surgical Oncology | 6 | 0.0% |
| Colorectal Surgery (Proctology) | 5 | 0.0% |
| General Dentistry | 5 | 0.0% |
| Hand Surgery | 5 | 0.0% |
| Medical Genetics And Genomics | 4 | 0.0% |
| Medical Oncology | 4 | 0.0% |
| Oral And Maxillofacial Pathology | 4 | 0.0% |
| Thoracic Surgery | 4 | 0.0% |
| Undefined Physician Type (Specify) | 4 | 0.0% |
| Cardiac Surgery | 3 | 0.0% |
| Certified Registered Nurse Anesthetist (Crna) | 3 | 0.0% |
| General Dentist | 3 | 0.0% |
| Geriatric Psychiatry | 3 | 0.0% |
| Hospitalist | 3 | 0.0% |
| Neonatology | 3 | 0.0% |
| Oral Medicine | 3 | 0.0% |
| Orofacial Pain | 3 | 0.0% |
| Orthodontist | 3 | 0.0% |
| Prosthodontist | 3 | 0.0% |
| Qualified Audiologist | 3 | 0.0% |
| Reproductive Endocrinology & Infertility | 3 | 0.0% |
| Critical Care (Intensivists) | 2 | 0.0% |
| Denitst | 2 | 0.0% |
| Occupational Medicine | 2 | 0.0% |
| Physical Therapist In Private Practice | 2 | 0.0% |
| Psychology | 2 | 0.0% |
| Qualified Speech Language Pathologist | 2 | 0.0% |
| Adult Congenital Heart Disease (Achd) | 1 | 0.0% |
| Chiropractic | 1 | 0.0% |
| Cosmetic Surgery Aesthetic Medicine | 1 | 0.0% |
| Counselor Mental Health | 1 | 0.0% |
| Counselor Professional | 1 | 0.0% |
| Doctor Of Medicine | 1 | 0.0% |
| Family Medicine | 1 | 0.0% |
| Gneral Dentist | 1 | 0.0% |
| Hematology | 1 | 0.0% |
| Integrative Medicine | 1 | 0.0% |
| Medical Toxicology | 1 | 0.0% |
| Nuclear Medicine | 1 | 0.0% |
| Occupational Therapist In Private Practice | 1 | 0.0% |
| Oral & Facial Surgeon | 1 | 0.0% |
| Oral And Maxillofacial Surgeru | 1 | 0.0% |
| Oral And Maxillofacial Surgery | 1 | 0.0% |
| Pediatric Denistry | 1 | 0.0% |
| Prosthdontics | 1 | 0.0% |
| Prosthodentist | 1 | 0.0% |
| Prosthodonics | 1 | 0.0% |
| Prosthodontic Dentistry | 1 | 0.0% |
| Prosthodontics Dentistry | 1 | 0.0% |
| Prosthodontists | 1 | 0.0% |
| Prosthontics | 1 | 0.0% |
| Psychologist | 1 | 0.0% |
| Radiation Oncology | 1 | 0.0% |
Opt-outs by state
California (11,000), New York (4,931), Texas (3,570), Washington (2,849), Florida (2,827) account for 43.5% of all records; California alone holds 19.0%. The state is the one on the provider's opt-out record, which can differ from where patients are seen.
| State | Records | Share |
|---|---|---|
| California | 11,000 | 19.0% |
| New York | 4,931 | 8.5% |
| Texas | 3,570 | 6.2% |
| Washington | 2,849 | 4.9% |
| Florida | 2,827 | 4.9% |
| Massachusetts | 2,175 | 3.8% |
| Illinois | 2,158 | 3.7% |
| North Carolina | 1,965 | 3.4% |
| Virginia | 1,928 | 3.3% |
| Maryland | 1,915 | 3.3% |
| Pennsylvania | 1,788 | 3.1% |
| New Jersey | 1,524 | 2.6% |
| Oregon | 1,395 | 2.4% |
| Colorado | 1,362 | 2.4% |
| Georgia | 1,306 | 2.3% |
| Arizona | 1,263 | 2.2% |
| Ohio | 837 | 1.4% |
| Michigan | 799 | 1.4% |
| Minnesota | 761 | 1.3% |
| Connecticut | 716 | 1.2% |
| Wisconsin | 713 | 1.2% |
| Tennessee | 676 | 1.2% |
| Utah | 674 | 1.2% |
| Missouri | 647 | 1.1% |
| Indiana | 612 | 1.1% |
| South Carolina | 602 | 1.0% |
| Iowa | 551 | 1.0% |
| Idaho | 533 | 0.9% |
| District of Columbia | 494 | 0.9% |
| Oklahoma | 493 | 0.9% |
| Kansas | 410 | 0.7% |
| Alabama | 383 | 0.7% |
| New Hampshire | 364 | 0.6% |
| Nevada | 277 | 0.5% |
| Alaska | 272 | 0.5% |
| New Mexico | 272 | 0.5% |
| Louisiana | 270 | 0.5% |
| Maine | 259 | 0.4% |
| Vermont | 249 | 0.4% |
| Nebraska | 243 | 0.4% |
| Montana | 213 | 0.4% |
| Arkansas | 212 | 0.4% |
| Mississippi | 204 | 0.4% |
| Kentucky | 199 | 0.3% |
| Hawaii | 179 | 0.3% |
| Rhode Island | 178 | 0.3% |
| South Dakota | 126 | 0.2% |
| Delaware | 124 | 0.2% |
| Wyoming | 84 | 0.1% |
| West Virginia | 81 | 0.1% |
| North Dakota | 79 | 0.1% |
| Puerto Rico | 32 | 0.1% |
| U.S. Virgin Islands | 3 | 0.0% |
| Northern Mariana Islands | 2 | 0.0% |
| Guam | 1 | 0.0% |
Opt-outs by effective year
The effective dates cluster in two waves. The first builds through 2012 to 2016, with 5,892 records dated 2016. The second is 2024: 15,737 records, 4.9 times the 3,206 of 2023, and 10,721 of them are marriage and family therapists and mental health counselors. Medicare Part B began to cover services of those two professions on January 1, 2024 (Consolidated Appropriations Act, 2023, section 4121), and only 25 records for the two professions are dated before 2024.
| Year | Records | Count |
|---|---|---|
| 2008 | 55 | |
| 2009 | 69 | |
| 2010 | 112 | |
| 2011 | 94 | |
| 2012 | 797 | |
| 2013 | 1,484 | |
| 2014 | 1,594 | |
| 2015 | 3,551 | |
| 2016 | 5,892 | |
| 2017 | 3,223 | |
| 2018 | 2,262 | |
| 2019 | 2,262 | |
| 2020 | 1,642 | |
| 2021 | 2,027 | |
| 2022 | 2,387 | |
| 2023 | 3,206 | |
| 2024 | 15,737 | |
| 2025 | 6,817 | |
| 2026 | 4,424 |
The five behavioral health specialties by the year their opt-out took effect. Clinical psychologists, clinical social workers and psychiatrists appear in every year; marriage and family therapists and mental health counselors appear almost entirely from 2024.
| Year | Clinical psychologists | Mental health counselors | Clinical social workers | Marriage and family therapists | Psychiatrists | All specialties |
|---|---|---|---|---|---|---|
| 2019 | 553 | 0 | 385 | 0 | 280 | 2,262 |
| 2020 | 372 | 0 | 221 | 0 | 187 | 1,642 |
| 2021 | 451 | 0 | 318 | 0 | 215 | 2,027 |
| 2022 | 516 | 0 | 357 | 0 | 247 | 2,387 |
| 2023 | 717 | 14 | 785 | 10 | 263 | 3,206 |
| 2024 | 1,038 | 5,354 | 1,996 | 5,367 | 261 | 15,737 |
| 2025 | 839 | 1,612 | 1,090 | 984 | 282 | 6,817 |
| 2026 | 495 | 879 | 688 | 521 | 196 | 4,424 |
Effective dates, end dates and renewal
An opt-out period lasts two years and renews automatically unless the provider cancels before it ends. The file's dates fit that rule: in 43,876 records the end date is four or more years after the effective date, in two-year steps for all but 2 of them, so the effective date marks when the first opt-out period began and the end date closes the current period. 13,904 records are still in their first two-year period. Read the effective-year counts as when providers first opted out, not when they last renewed.
| Years | Records |
|---|---|
| 2 | 13,904 |
| 4 | 17,067 |
| 6 | 4,226 |
| 8 | 3,992 |
| 10 | 5,839 |
| 11 | 1 |
| 12 | 8,802 |
| 14 | 3,019 |
| 15 | 1 |
| 16 | 592 |
| 18 | 153 |
| 20 | 63 |
| 22 | 48 |
| 24 | 31 |
| 26 | 15 |
| 28 | 19 |
| 30 | 8 |
| Period ends | Records |
|---|---|
| 2026 | 6,593 |
| 2027 | 22,798 |
| 2028 | 28,389 |
What an opt-out means for billing
Medicare does not pay an opted-out provider, or the beneficiary, for services under a private contract; the patient pays the agreed amount. Groups that employ or contract with behavioral health clinicians need to know who has opted out before they bill Medicare under a clinician's NPI, and should re-check when a clinician joins, because the opt-out follows the provider, not the practice.
Ordering is separate from billing. 30,296 records (52.4%) are flagged eligible to order and refer, so labs, imaging centers and DME suppliers can still bill Medicare for those providers' orders; for the other 27,484 the order-and-refer check fails. Medicare enrollment status and revalidation are managed in PECOS, and the credentialing file for each clinician is where the status should live.
Method and privacy
The August 2026 opt-out affidavit file is read from data.cms.gov as published. Only the specialty, state, effective date, end date, order-and-refer flag and last-updated date reach the computation; NPIs are used to count distinct providers and are not stored. Names, NPIs and addresses do not appear on this page or in the CSV. Records with a last-updated date up to 2026-09-15 are included. CMS refreshes the file monthly. See the reference methodology.
Download the full table
The CSV holds the record counts by specialty, state, effective year, end year, period length and order-and-refer eligibility (aggregates only): 225 rows, one header row and the columns dimension, value, count, pct of rows. Its first line is a comment that names each CMS source file with its SHA-256, the data date and the attribution line to keep when you reuse the table.
Table SHA-256 (the rows after the comment line): 2a04790131cb80de8de0b975fade5c9abff19c41194951dac05d0cd2f50d613e. Data as of 2026-09-15.
Where QuickIntell fits with provider enrollment
QuickIntell's credentialing software organizes provider profiles, payer applications, enrollment status and renewal tracking with review controls, which is where a clinician's Medicare opt-out status belongs before claims go out.
Frequently asked questions
How many providers have opted out of Medicare?
The August 2026 CMS opt-out file lists 57,780 opt-out records for 57,015 distinct providers; 706 providers appear on more than one row.
Which specialties opt out of Medicare most?
Clinical Psychologist (7,899), Mental Health Counselor (7,860), Clinical Social Worker (7,580), Marriage And Family Therapist (6,882), Psychiatry (5,017). The five behavioral health specialties together account for 35,238 records, 61.0% of the file; dentists and oral surgeons account for 8,451.
Why did opt-outs jump in 2024?
15,737 records have an effective date in 2024, against 3,206 in 2023. 10,721 of the 2024 records are marriage and family therapists (5,367) and mental health counselors (5,354), the two professions Medicare Part B began to cover on January 1, 2024 under section 4121 of the Consolidated Appropriations Act, 2023. Only 25 records for the two professions carry an earlier date.
How long does a Medicare opt-out last?
An opt-out runs for two years and renews automatically for further two-year periods unless the provider cancels before the period ends. In this file 43,876 records have an end date four or more years after the effective date, in two-year steps for all but 2 of them, which is consistent with the effective date marking the first opt-out period and the end date the end of the current period; 13,904 records are in their first two-year period.
Can an opted-out provider still order tests for Medicare patients?
The file flags whether each opted-out provider is eligible to order and refer: 30,296 records (52.4%) are marked eligible and 27,484 are not. Laboratories, imaging centers and DME suppliers check this flag before billing Medicare for an order.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.
- Medicare Opt-Out Affidavits, August 2026 fileVersion August 2026 (data.cms.gov) · effective 2026-09-15 · file OptOut_August2026.csvSHA-256 16508f104a3b8040…
Disclaimer
Counts describe the CMS file as published; check an individual provider's status in the CMS file or PECOS before billing. Operational reference, not legal or billing advice.
Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.