MLN: 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.
Primary source
CMS Advance Beneficiary Notice (ABN) Form CMS-R-131 →https://www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative-bni/fee-service-fffs-non-participating-providers
Verified May 23, 2026 · This is the authoritative regulator URL. The summary below is a research aid; the linked source controls.
Additional sources
The Advance Beneficiary Notice of Noncoverage (ABN, Form CMS-R-131) is required when a provider believes Medicare may not cover an item or service that would normally be a Medicare benefit. Issuing a proper ABN before the service shifts financial responsibility for the noncovered amount to the beneficiary if Medicare ultimately denies the claim.
The current ABN form and instructions are on the CMS Beneficiary Notices Initiative page.
Required content:
- Identification of the specific items/services that may be denied.
- The specific reason the provider believes Medicare may deny.
- An estimated cost the beneficiary may have to pay.
- Three options the beneficiary may select: receive and have the provider bill Medicare; receive and not have Medicare billed; do not receive.
- Beneficiary signature and date.
ABNs are typically used for items/services that may exceed Medicare frequency limits, that may be deemed not medically necessary, or that may not be Medicare-covered benefits in the specific circumstance (e.g., screening tests for asymptomatic patients in a beneficiary outside the covered population).
Modifier GA (waiver of liability statement issued) is appended to the claim line to signal a valid ABN is on file; modifier GZ signals the item is expected not to be covered and no ABN was issued.
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Related regulations
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Last reviewed May 23, 2026 · Citation verified May 23, 2026
Research aid, not legal advice. This summary is an administrative research aid prepared by D3rx. It does not certify compliance, provide legal advice, replace counsel, or guarantee an audit outcome. For authoritative regulatory text follow the primary source link at the top of this page. The practice remains responsible for reviewing, adopting, and maintaining its compliance program.