US · guidance
CMS Pub. 100-04, ch. 30, § 400.3.8
Completing the Additional Information Field of the MOON
This section may be populated with any additional information a hospital wishes to
convey to a beneficiary.
Such information may include, but is not limited to:
• Contact information for specific hospital departments or staff members.
• Additional content required under applicable State law related to notice of
observation services.
• Part A cost-sharing responsibilities if a beneficiary is admitted as an inpatient
before 36 hours following initiation of observation services.
• The date and time of the inpatient admission if a patient is admitted as an
inpatient prior to delivery of the MOON.
• Medicare Accountable Care Organization information.
• Hospital waivers of the beneficiary’s responsibility for the cost of self-administered drugs.
• Any other information pertaining to the unique circumstances regarding the
particular beneficiary.
If a hospital or CAH wishes to add information that cannot be fully included in the
“Additional Information” section, an additional page may be attached to supplement the
MOON.
History
(Rev. 3698, Issued: 01-27-17, Effective: 02-21-17; Implementation: 02-21-17)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
94a08f618d2e527762ae83a3dbfb4e7292f0fb86b47fc7a85a5892cd0cfe36b3
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