ABN (Advance Beneficiary Notice of Non-coverage)
Advance Beneficiary Notice of Non-coverage
A standardized notice (CMS-R-131) given to Medicare fee-for-service beneficiaries before furnishing a service Medicare may not cover.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Denials & Appeals
- Acronym for
- Advance Beneficiary Notice of Non-coverage
- Primary sources
- 1
- Workspace handoff
- templates →
Where this comes up
This is denial-workbench territory. A remit posts with a CARC/RARC, the biller decides whether to rebill, appeal, or write off, and the appeal packet has to cite the chart, the order, and the payer's own policy language. Recurring patterns trace back to an upstream workflow gap.
Full definition
What it is in practice
CMS ABN requires providers to notify beneficiaries when Medicare is likely to deny payment. A valid ABN shifts financial responsibility to the patient. Modifier GA on the claim indicates a signed ABN; modifier GZ indicates Medicare deemed not necessary, no ABN.
How it shows up in your practice
Pre-screen ICD-CPT pairs against the applicable LCD/NCD. Issue the ABN before the service. Use the right modifier on the claim.
Sources
- CMS — Advance Beneficiary Notice of Non-coverage (ABN)https://www.cms.gov/medicare/billing/abns
Pull the ABN template
Open templates →Related terms
- PayerLCD (Local Coverage Determination)A MAC-published decision about whether a service is reasonable and necessary in its jurisdiction.
- CodingMedical NecessityThe standard requiring that services be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.
- Denials & AppealsGA ModifierHCPCS modifier indicating an Advance Beneficiary Notice of Non-coverage (ABN) was issued and is on file.
- Denials & AppealsGZ ModifierHCPCS modifier indicating an ABN was not issued for a service Medicare is expected to deny as not reasonable and necessary.
D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- GlossaryGA ModifierHCPCS modifier indicating an Advance Beneficiary Notice of Non-coverage (ABN) was issued and is on file.
- GlossaryGZ ModifierHCPCS modifier indicating an ABN was not issued for a service Medicare is expected to deny as not reasonable and necessary.
- GlossaryLCD (Local Coverage Determination)A MAC-published decision about whether a service is reasonable and necessary in its jurisdiction.
- GlossaryMedical NecessityThe standard requiring that services be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.
- GlossaryPR-204 (Non-Covered Service)Patient Responsibility 204 — patient is responsible for amounts the plan does not cover, often when an ABN or similar notice is on file.
- BillingHow to Appeal an Insurance Denial: Step-by-Step GuideClaim denied? Step-by-step appeal process with payer deadlines, denial code fixes, appeal letter template, and escalation options.
- BillingMedical Billing Denial Codes: What They Mean and How to Fix ThemCO-4, CO-97, CO-16, PR-96 and more. What each denial code means and exactly how to fix it.
- RegulationMLN: Advance Beneficiary Notice of Noncoverage (ABN, CMS-R-131)Reference to Medicare's ABN form required before furnishing items or services Medicare may not cover, shifting financial responsibility to the beneficiary.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.