The Fee-for-Service Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, was implemented by the Centers for Medicare & Medicaid Services to inform Part B original beneficiaries when Medicare may deny payment for an item or service. The information below can help health care professionals understand the Medicare requirements for when and how to issue an ABN.
ABNs allow beneficiaries to make informed decisions about whether to get services and accept financial responsibility for services Medicare does not cover. The ABN serves as proof the beneficiary was informed prior to receiving a service Medicare may not pay. If a valid ABN is not issued to a beneficiary when Medicare requires it, the practice cannot bill the beneficiary for the service and you may be financially liable if Medicare doesn’t pay.
You may also use the ABN as an optional (voluntary) notice to alert beneficiaries of their financial liability prior to providing care that Medicare never covers. ABN issuance is not required to bill a beneficiary for an item or service that is not a Medicare benefit and never covered.
It is necessary to issue an ABN when:
See E/M Coding Guidelines >
Common reasons for Medicare to deny an item or service as not medically reasonable and necessary include care that is:
ABN Form - English
ABN Form - Spanish
Practice Management Staff