All About ABNs

What is an ABN?

An ABN is an Advanced Beneficiary Notice of Noncoverage. The provider gives the ABN to a Medicare patient prior to providing an item that may not be covered or is statutorily excluded from Medicare benefits.

The ABN provides the patient an opportunity to decide about receiving the item and accepting financial responsibility if the claim is denied.

When is an ABN used?

The ABN is used only for Medicare patients and under one of the following scenarios:

• Lack of medical necessity
• No DMEPOS supplier number
• Same or Similar item may have been dispensed
• Non-contract supplier in a competitive bid area

Where can I get an ABN?

The most current ABN, Form CMS-R-131 can be downloaded here.

How do I complete the ABN?

An interactive tutorial on correctly completing the ABN can be found here.

A few final points regarding the Advanced Beneficiary Notice:  

• ABN is used only for Medicare patients. Medicare Advantage plans and private pay plans may have their own forms to utilize.
• Medicare frowns upon using ABNs for all patients. Use it only when there is reasonable expectation the item will not be covered.

You can learn more about ABNs from the DME MAC sites:

• Noridian, Jurisdiction A and D
• CGS, Jurisdiction B and C