Please select the exempt billing option that applies to you:
- Self-Pay or Out-of-Network Insurance
- Medicare / Medicaid
- Tricare / Veterans Affairs (VA)
- Health Share / Cost Share
Patients with Medicare Part B seeking services covered under Medicare Part B pursuant to section 4507 of the Balanced Budget Act of 1997: the medical provider has informed the patient and/or the legal representative that the physician has opted out of the Medicare program effective September 2007.