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Advance Beneficiary Notice of Noncoverage (ABN)

An Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, is a standardized notice that a health care provider/supplier must give to a Medicare beneficiary, before providing certain Medicare Part B or Part A items or services. This ABN must be issued when the health care provider (including independent laboratories, physicians, practitioners and suppliers) believes that Medicare may not pay for an item or service because of:

  • Medical necessity
  • Frequency limitations
  • Discontinued services
  • Experimental and investigational
  • Not safe or proven effective

The ABN gives the beneficiary the opportunity to make an informed decision prior to the procedure or service being rendered to decide whether to receive the service and accept financial responsibility if denied by Medicare. This ABN serves as proof that the beneficiary had knowledge prior to receiving the service that Medicare might not cover. If the provider does not deliver a valid ABN to the beneficiary when required, the beneficiary cannot be billed for the service and the provider may be held financially liable.

An ABN must not be used for all services and are not required for services that are statutorily excluded – examples include:

  • Vitamins
  • Nutritional counseling
  • X-rays
  • Office visit
  • Therapy

A Single ABN is acceptable when:

  • the ABN identifies all items/services and duration of period of treatment
  • No treatment changes have ocurred
  • Services have not been added/deleted

If there are ANY changes, a new ABN is required.

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Last Updated Mar 16, 2017