CMS Beneficiary Notices

Both Medicare beneficiaries and providers have certain rights and protections related to financial liability and appeals under the fee-for-service (FFS) Medicare program. These financial liability and appeal rights and protections are communicated to beneficiaries through advance notices given by providers.

• Please refer to the CMS Beneficiary Notices Initiative page for a complete listing of acceptable beneficiary notices and their associated instructions.

Advance Beneficiary Notice of Non-coverage (ABN)

Note: The ABN, Form CMS-R-131, and form instructions have been approved by the Office of Management and Budget (OMB) for renewal. The use of the renewed form with the expiration date of January 31, 2026, will be mandatory on or after June 30, 2023. 

The ABN is an OMB-approved written notice issued by healthcare providers and suppliers for items and services provided under Medicare Part B. Except for durable medical equipment (DME) suppliers, only health care providers and suppliers who are enrolled in Medicare can issue the ABN to beneficiaries. 

• The ABN should be given to beneficiaries enrolled in the Medicare FFS program. It should not be used for items or services provided under the Medicare Advantage (MA) Program or for prescription drugs provided under the Medicare Prescription Drug Program (Part D). The ABN is used to fulfill both mandatory and voluntary notice functions.
• The current version of the ABN is available via the link at: Fee-for-Service ABN.
  • The ABN must be given by providers / suppliers of:
    • Items and services provided under Medicare Part B, including hospital outpatient services, and SNF services
    • Items and services provided under Medicare Part A by hospice and religious non-medical healthcare institutes (RNHCIs)

• The ABN must be given to beneficiaries enrolled under the Medicare FFS program based on the following guidelines:

  • Prior to providing an item or service that is usually paid for by Medicare under Part B (or under Part A for hospice and RNHCI providers only) but may not be paid for in this case because it is not considered medically reasonable and necessary
  • Prior to providing custodial care
  • Prior to caring for a patient who is not terminally ill (hospice providers only)
  • Prior to providing care when the individual is not confined to the home or does not need intermittent skilled nursing care (for home health aid [HHA] providers only)

  Note: The provision of the ABN is optional prior to providing an item or service that is never covered by Medicare (not a Medicare benefit).

For additional guidance regarding the use of the ABN, please refer to Chapter 30 of the CMS Medicare Claims Processing Manual.