US · guidance
CMS Pub. 100-04, ch. 18, § 80.8
Advanced Beneficiary Notice (ABN) as Applied to the IPPE
If a second IPPE is billed for the same beneficiary, it would be denied based on Section 1861(s)(2) of the Act, since
the IPPE is a one-time benefit, and an ABN would not be required in order to hold the beneficiary liable for the cost
of the second IPPE. However, an ABN should be issued for all IPPEs conducted after the beneficiary’s statutory 6-month period has lapsed since based on Section 1862(a)(1)(K), Medicare is statutorily prohibited from paying for an
IPPE outside the initial 6-month period under the MMA of 2003. Effective for dates of service on or after January 1,
2009, an ABN should be issued for all IPPEs conducted after the beneficiary’s statutory 12-month period has lapsed
since based on Section 1862(a)(1)(K), Medicare is statutorily prohibited from paying for an IPPE outside the initial
History
(Rev. 1615, Issued: 10-17-08, Effective: 01-01-09, Implementation: 01-05-09)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
462a6da8b74ae3c95c1140e0bcfeff17608c0bfed0e510da92c039538df57927
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