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MA47 Remark Code: Provider Opted Out of Medicare

MA47 means Medicare's records show the provider has opted out of Medicare and agreed with the patient not to bill Medicare for these services, tests, or supplies. Medicare therefore cannot pay the claim, and the patient is responsible for payment.

Code: MA47 (RARC MA47)
Status: Active In use since January 1, 1997.
Code set: Remittance Advice Remark Codes (RARC)
Group codes: PR (Patient Responsibility): The patient is responsible for payment under the private arrangement with the opted-out provider.
CO (Contractual Obligation): Some remittances report the denied amount under CO. Check the private contract terms before billing the patient.
Official description: Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished. As result, we cannot pay this claim. The patient is responsible for payment.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified: September 24, 2026 against the official X12 list.

What MA47 means

Practitioners who opt out of Medicare agree not to bill Medicare, and instead sign private contracts with their Medicare patients. MA47 tells you Medicare has you on record as opted out, so it will not pay this claim and considers the patient responsible under that arrangement.

This code is a Medicare enrollment status message. If you did opt out, the claim should not have been sent. If you did not, the status needs urgent attention.

Common causes

The provider opted out, but the office submitted a claim anyway.
The claim listed an opted-out practitioner as the rendering provider when another provider performed the service.
The provider’s opt-out period was believed to have ended, but Medicare still shows it active.
An enrollment error recorded an opt-out that was never intended.

How to fix it

Confirm the provider’s opt-out status with the Medicare enrollment contractor.
Check the rendering provider on the claim, box 24J, and correct it if a different provider furnished the service.
If opted out, handle payment with the patient under the private contract and stop submitting claims for that provider.
If the status is wrong, correct the enrollment record, then ask whether the claim can be reopened.

How to prevent it

Maintain a list of opted-out providers and block claim creation for them in your billing system. Enrollment status problems are explained in provider enrollment denials.

Codes that may appear with MA47

CO-B7 (This provider was not certified/eligible to be paid for this procedure/service on this date of service.): The provider was not eligible to be paid for the service on the date of service.
CO-96 (Non-covered charge(s).): The charge is treated as non-covered under Medicare.

MA56 (Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished.): A similar opt-out message that adds a limit on what the patient may be charged.
M143 (The provider must update license information with the payer.): The provider must update license information, a different enrollment issue.
MA12 (You have not established that you have the right under the law to bill for services furnished by the person(s) that furnished this (these) service(s).): The right to bill for services furnished by others has not been established.

MA47 FAQ

What does opting out of Medicare mean?

An eligible practitioner can opt out and enter private contracts with Medicare patients. The patient pays the practitioner directly, and neither submits claims to Medicare for covered services, except in limited situations.

What if we did not opt out?

Contact Medicare's enrollment contractor right away. A wrong opt-out status must be corrected in the enrollment record before claims can be paid.

What if a different provider in the group opted out?

Check the rendering NPI in box 24J. If the wrong provider was listed, submit a corrected claim with the provider who actually furnished the service.

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