Renewed Version of Medicare Advance Beneficiary Notice of Noncoverage (ABN)

August 1, 2017

An Advance Beneficiary Notice (ABN), Form CMS-R-131, is a written notice which a physician, provider, or supplier gives to a Medicare beneficiary before items or services are furnished when the physician, provider (including independent laboratories, home health agencies, and hospices), or supplier believes that Medicare probably or certainly will not pay for some or all of the items or services.

The ABN form and form instructions have been approved by the Office of Management and Budget (OMB) for renewal. The new ABN form is effective for use on and after June 21, 2017, with an expiration date of March 2020.

If you have not already done so, please incorporate the new form in to your physician practice as soon as possible.

Note: Use of the old ABN form (version 03/11) will be considered invalid.

Renewed Version

image of renewed ABN form

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