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FFS SNFABN and SNF Denial Letters

Skilled Nursing Facilities (SNFs) must issue a liability notice to Original (fee for service) Medicare beneficiaries before the SNF provides:

  • an item or service that is usually paid for by Medicare, but may not be paid for in this particular instance because it is not medically reasonable and necessary, or
  • custodial care.

For Part A items and services: SNFs may use either the Skilled Nursing Facility Advance Beneficiary Notice (SNFABN) or one of the five SNF denial letters as the liability notice.

For Part B items and services: SNFs must use the Advanced Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131. The ABN and  information on this notice can be found at

To download these notices and accompanying instructions, please click on the appropriate link below.


Questions regarding the ABN, SNFABN or SNF denial letters can be emailed to