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FFS ABN

Fee For Service Advance Beneficiary Notice of Noncoverage
The Advanced Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, is issued by providers (including independent laboratories, home health agencies, and hospices), physicians, practitioners, and suppliers to Original Medicare (fee for service) beneficiaries in situations where Medicare payment is expected to be denied. Guidelines for mandatory and voluntary use of the ABN are published in the Medicare Claims Processing Manual, Chapter 30, Section 50

Home Health Agencies (HHAs) now use the ABN in place of the Home Health Advance Beneficiary Notice (HHABN), Option Box 1, Form CMS-R-296. Please check the HHCCN web page for more information on the discontinuation of the HHABN and notice requirements for HHAs.

Note: Skilled nursing facilities (SNFs) must use the ABN for items/services expected to be denied under Medicare Part B only.

Download the ABN

The ABN and the ABN form instructions are posted below under "Downloads". The current version of the ABN has the form approval date of 3/2011 printed in the lower left hand corner.

Questions?

Questions regarding the ABN can be emailed to RevisedABN_ODF@cms.hhs.gov .