New ABN Form

The newly updated ABN is effective immediately and is valid through March 31, 2029. DME suppliers may continue to use the expired version of the ABN until May 12, 2026, but must fully transition to the OMB‑approved form no later than that date.

The updated ABN, instructions, and alternative formats (including large print and Spanish versions) are available on the CMS FFS ABN webpage.

Advance Beneficiary Notice of Noncoverage (ABN)

An Advance Beneficiary Notice of Noncoverage (ABN) is a written notice that a supplier or healthcare provider gives a Medicare Fee-for-Service (FFS) beneficiary before delivering an item or service. Providers, including physicians, practitioners, independent labs, and suppliers must issue an ABN when they believe Medicare may not pay for the item or service because it falls under one of Medicare’s statutory exclusions such as:

  • Item or service is not reasonable and necessary
  • Prohibited, unsolicited telephone contacts
  • Supplier number requirements not met
  • Denial of an Advanced Determination of Medicare Coverage (ADMC) or Prior Authorization request
  • Non-contract supplier furnishing an item listed in a Competitive Bid area
  • Frequency limitations have been exceeded
  • Medicare considers an item or service experimental

An ABN gives a Medicare FFS beneficiary the chance to make an informed choice before receiving an item or service that may not be covered. It explains that the patient may have to pay out of pocket (or use other insurance) if Medicare denies the claim, and it documents that the patient was told this in advance. If a provider fails to issue a valid ABN when required, the patient cannot be billed for the item or service, and the provider may be held financially liable.

On this page, you’ll find information about:

ABN

The FFS ABN serves two key purposes:

  • Ensures the beneficiary is informed in advance that Medicare may not pay
  • Protects the provider’s ability to bill the beneficiary if Medicare denies the claim

Without a valid ABN when required, the provider may be financially liable for the denied item/service. This prior notice to the beneficiary allows the provider to transfer potential financial liability when Medicare coverage requirements are not expected to be met An ABN remains valid after proper delivery as long as none of the following factors change:

  • The care being provided remains the same as what was described on the original ABN.
  • The beneficiary’s health status has not changed in a way that would alter the treatment plan for the non‑covered condition.
  • Medicare coverage guidelines for the items or services have not changed (including policy updates or revisions).

If any of these elements change during the course of treatment, a new ABN must be issued.

For services that are repetitive or ongoing, providers may issue a new ABN after one year for continued treatment of the non‑covered condition. However, this is optional unless one of the conditions above applies.

A single ABN may be used to describe an extended or repetitive course of non‑covered treatment, if it includes all items and services the provider believes Medicare will not cover. When applicable, the ABN must also specify the expected duration of treatment. If additional non‑covered items or services become necessary or treatment changes during the treatment period, a new ABN must be issued.

Form

For an ABN form to be acceptable, it must:

  • Be on approved ABN, Form CMS-R-131
    • Notifiers are expected to exclusively use the current version of the ABN
    • New Office of Management and Budget (OMB) ABN form is issued every three years by CMS
  • Clearly identify item(s) and/or service(s); and
  • Give reason(s) for belief that Medicare is likely (or certain) to deny payment for item(s) and/or service(s)

ABNs apply to assigned and non-assigned claims, as there are financial liability provisions under Medicare law for both claim types. ABN instructions can be found on the CMS website with the ABN, Form CMS-R-131, which is linked above.

Limitations of Liability (LOL)

LOL applies to assigned claims for DMEPOS services not payable due to not meeting reasonable and necessary requirements, due to prohibition of unsolicited telephone calls, supplier number requirements not met, or Prior Authorization or ADMC requirements not met. Under LOL, a beneficiary can be held liable for a service denied due to reasons cited on the ABN.

The financial liability protections (FLP) provisions of the Social Security Act (the Act) protect beneficiaries and health care providers (physicians, practitioners, suppliers, and providers) under certain circumstances from unexpected liability for charges associated with claims that Medicare does not pay. The FLP provisions include:

Refund Requirements (RR)

Refund Requirements apply to both assigned and non‑assigned DMEPOS claims that are denied because they do not meet Medicare’s reasonable and necessary criteria, involve prohibited unsolicited telephone contacts, fail to meet supplier number requirements, or do not meet Prior Authorization or ADMC requirements. If a beneficiary wasn’t properly informed that Medicare might deny a claim, the Refund Requirements state that suppliers must return any money they collected. These rules ensure that a beneficiary is notified in advance and agrees to take on financial responsibility before the item or service is provided.

Prior to rendering a service in which Medicare may consider not medically necessary, a supplier should notify the beneficiary, in writing, that Medicare will likely deny the claim and the beneficiary will be responsible for payment. The supplier will submit the appropriate HCPCS and append the GA modifier indicating a valid ABN is on file.

Reason Medicare May Not Pay Examples:

Appropriate

  • "The patient does not have the required diagnosis to qualify for this item per the policy."
  • "The patient currently has a nebulizer (E0570) paid for by Medicare on 12/2/2013 which is same or similar to this nebulizer (E0570)."
  • "There are no test results available to determine the patient qualifies for oxygen equipment under Medicare guidelines."

Not Appropriate

  • "Medicare might not pay for this item."
  • "Patient might have same or similar item on file."
  • "Not enough supporting documentation in the medical record."

NOTE: General statements, such as "Medicare may not pay," are not acceptable.

If a beneficiary disagrees with the amount Medicare paid, if coverage for a service or item is denied, or if Medicare takes too long to process a claim, they have the right to appeal the decision. A supplier may also appeal a claim decision, but only when they accept assignment for that claim.

Optional ABN Uses

CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 30, Section 50.2.1

ABNs are not required for care that is either statutorily excluded from coverage under Medicare (i.e., care that is never covered) or most care that fails to meet the definition of any Medicare benefit. However, CMS does encourage an ABN be used in these situations to voluntarily notify Medicare beneficiaries of an expected denial.

When statutorily excluded items are provided to a beneficiary and a voluntary ABN is obtained, the ABN serves as a courtesy to the beneficiary forewarning them of financial obligation. The beneficiary should not choose an option box or be required to sign the ABN.

Statutorily Excluded Items or Situations (Not all inclusive)

  • Raised toilet seats
  • Grab Bars
  • Personal comfort items
  • Incontinence garments (e.g., adult briefs)

Items or Situations Which Do Not Meet Definition of a Medicare Benefit (Not all inclusive)

  • Parenteral or enteral nutrients used to treat a temporary rather than a permanent condition
  • Enteral nutrients taken orally
  • Infusion drugs not administered through a durable infusion pump
  • Surgical dressings used for cleansing a wound, cleaning intact skin, or protecting intact skin
  • Irrigation supplies used to irrigate skin or wounds
  • Immunosuppressive drugs used for conditions other than post–organ transplant care
  • Most oral medications
  • Oral anticancer drugs when no injectable or infusion form exists
  • Nondurable items not covered under another benefit category (e.g., incontinence products)
  • Durable items not primarily intended for a medical purpose (e.g., exercise equipment)

Per Section 1848(g)(4) of the Social Security Act, suppliers are not required to submit a claim to Medicare when an item(s) is categorically excluded from Medicare benefits (e.g., tub/shower stools, personal comfort items, etc.); however, if a beneficiary requests a supplier submit a claim, a supplier must comply. The claim must include the appropriate HCPCS, but modifiers GA or GY are not required. The supplier and the Medicare beneficiary will receive a Patient Responsibility (PR) denial for the non-covered services.

Beneficiary Changes His/her Mind

If a beneficiary changes his/her mind after completing and signing the ABN, the notifier should provide the beneficiary with the original ABN and request an annotation. This annotation must clearly state the beneficiary’s new option choice and include the beneficiaries’ signature and date of the change.

If the notifier cannot meet with the beneficiary in person, the notifier may document the beneficiary’s new choice on the ABN, then immediately send a copy to the beneficiary to sign, date, and return. In both situations, the beneficiary should receive a copy of the updated ABN as soon as possible.

If a related claim has already been submitted, the claim must be corrected as needed to reflect the beneficiary’s updated decision.

CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 30, Section 50.6 - Financial Liability Protections

Providers Not Participating in Medicare Part B Versus DME Suppliers Without a Supplier Number

The ABN is an OMB-approved written notice issued by healthcare providers and suppliers for items and services provided under Medicare Part B. Except for DME suppliers, only healthcare providers and suppliers who are enrolled in Medicare can issue the ABN to beneficiaries. The ABN is provided to beneficiaries enrolled in the Medicare FFS program.

Per CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 30, Section 50.1 if a Part B provider is not participating in Medicare, they cannot utilize the ABN unless they are a DME supplier without a supplier number. If a DME supplier does not have a supplier number, they should obtain an ABN.

Resources

Last Updated Mar 31 , 2026