April 11, 2023
On April 4, 2023 CMS announced that the current Advanced Beneficiary Form (ABN) will expire on June 30, 2023. The updated ABN will go into effect on June 30, 2023 and expire on January 31, 2026.
The ABN is used by providers who know that a service is not covered or will be denied by the Medicare fee-for-service (FFS) program. Prior to providing the service, an ABN must be offered to the patient, so that they can decide whether or not to have the service and be financially responsible for the service. The ABN will list the service, the reason the service is not covered by Medicare, and an estimate of how much the patient can expect to pay. The patient will choose one of three options listed below and then sign and date the form:
- Option 1 – choose to have and pay for the service and have a claim sent to Medicare
- Option 2 – choose to have and pay for the service and DO NOT have a claim sent to Medicare
- Option 3 – choose NOT to have and pay for the service
If a patient chooses Options 1 or 2, then a modifier is added to the procedure code(s) of the service(s) listed on the ABN. Read more about using an ABN, what and when modifiers should be used: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/abn_booklet_icn006266.pdf
Find the updated ABN and ABN instructions here: https://www.cms.gov/medicare/medicare-general-information/bni/abn