Fact sheet

Medicare Outpatient Observation Notice (MOON)

Medicare Outpatient Observation Notice (MOON)

Enacted August 6, 2015, the Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act) requires hospitals and Critical Access Hospitals (CAH) to provide notification to individuals receiving observation services as outpatients for more than 24 hours explaining the status of the individual as an outpatient, not an inpatient, and the implications of such status. 

  • Hospitals and CAHs are required to furnish a new CMS-developed standardized notice, the Medicare Outpatient Observation Notice (MOON), to a Medicare beneficiary who has been receiving observation services as an outpatient. Under CMS’ final NOTICE Act regulation, published August 2, 2016, hospitals and CAHs may deliver the MOON to individuals receiving observation services as an outpatient before such individuals have received more than 24 hours of observation services. The notice must be provided no later than 36 hours after observation services are initiated or, if sooner, upon release;
  • The MOON will inform more than one million beneficiaries annually of the reason(s) they are an outpatient receiving observation services and the implications of such status with regard to Medicare cost sharing and coverage for post-hospitalization skilled nursing facility (SNF) services; and 
  • An oral explanation of the MOON must be provided, ideally in conjunction with the delivery of the notice, and a signature must be obtained from the individual, or a person acting on such individual’s behalf, to acknowledge receipt. In cases where such individual or person refuses to sign the MOON, the staff member of the hospital or CAH providing the notice must sign the notice to certify that notification was presented.

The standardized notice, the MOON, has gone through the Paperwork Reduction Act process, thus affording the public an opportunity to comment on the MOON.

The finalized, OMB-approved Medicare Outpatient Observation Notice (MOON) / CMS-10611, and form instructions are now available.  They can be found at 

Hospitals and CAHs must begin using the MOON no later than March 8, 2017. Manual instructions will be made available in the coming weeks.

Please visit the above webpage for more information.