Advance Beneficiary Notice of Noncoverage (ABN) - DIGITAL FORM

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UPDATED April 2023 following the OMB (Office of Management and Budget) approval for renewal. The CMS-R-131 ABN now expires 1/31/2026.

This renewed ABN will be mandatory for use on 6/30/2023. The renewed form may be implemented prior to the mandatory deadline.

This Advanced Beneficiary Notice provides the Medicare patient with advance notice of physician-ordered non-covered care. It is also used to notify the patient of reduction or termination of ongoing care when the physician does not concur.

CMS-R-131 is issued by providers (including independent laboratories, home health agencies, and hospices), physicians, practitioners, and suppliers to Original Medicare (fee for service - FFS) beneficiaries in situations where Medicare payment is expected to be denied. The ABN is issued in order to transfer potential financial liability to the Medicare beneficiary in certain instances.

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