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Advisory Opinions (AOs)

Section 1877(g)(6) of the Social Security Act (the Act) requires that CMS issue certain written advisory opinions. These opinions provide guidance on whether a physician's referrals for certain designated health services payable by Medicare to an entity with which he or she (or an immediate family member) has a financial relationship are prohibited under the Medicare program by section 1877 of the Act. We are making these advisory opinions available to the general public through this CMS website, as specified in our regulations at 42 CFR §411.384(b). The purpose of the advisory opinion process is to provide a binding opinion concerning the application of section 1877 of the Act to specific factual situations.

The requestor, who must be a party to the existing or proposed arrangement, is the only individual or entity that may rely on the advisory opinion.  In each opinion, we apply legal standards to a set of facts involving certain known persons and/or entities that have provided specific statements about key factual issues. Because each opinion applies to specific individuals or entities in specific situations, no third parties are bound by, nor may they legally rely on, an advisory opinion.

Before publication of the advisory opinion, we redact specific information about the requesting individuals or entities, and about any individuals or entities associated with the requestor, to the extent that it is appropriate.  In addition, we intend to protect from public disclosure, to the fullest extent permitted by Exemptions 4 and 6 of the Freedom of Information Act, 5 U.S.C.  §552(b)(4) and (b)(6), any confidential business information and any individual-specific information collected.  We note that CMS is prevented by the Trade Secrets Act, 18 U.S.C. §1905, from releasing confidential business information, except as authorized by law.

More detailed information on CMS Advisory Opinions can be found in 42 CFR §411.370-§411.389 (see the download below).

These opinions do not relate to specialty hospitals.  For specialty hospital advisory opinions, see the menu in the left column.

We note that the Office of the Inspector General has a similar process for securing advisory opinions.  For further information about their process and its requirements, see the link below.  (Related Links Outside CMS)

Downloads