US · guidance
CMS Pub. 100-04, ch. 30, § 450.3
Medicare Change of Status Notice (MCSN)
The Medicare Change of Status Notice (MCSN) is subject to the Paperwork Reduction
Act (PRA) process and approval by the Office of Management and Budget (OMB). The
MCSN may only be modified as per the accompanying instructions, as well as per
guidance in this section. Unapproved modifications cannot be made to the OMB-approved, standardized MCSN. The notice and accompanying instructions may be found
online at https://www.cms.gov/Medicare/Medicare-General-
Information/BNI/HospitalDischargeAppealNotices
450.3.1 Alterations to the MCSN
(Rev. 12934; Issued: 10-31-24; Effective: 11-15-24; Implementation: 02-14-25)
• The MCSN must remain two pages. The notice can be two sides of one page or
one side of two separate pages but must not be condensed to one page.
• Hospitals may include their business logo and contact information on the top of
the MCSN. Text may not be shifted from page one to page two to accommodate
large logos, address headers, etc.
• Hospitals may include information in the optional “Additional Information”
section relevant to the beneficiary’s situation.
History
(Rev. 12934; Issued: 10-31-24; Effective: 11-15-24; Implementation: 02-14-25)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
cda50d095633b0da184aa8ae2b75224ca14b48fc74ef00fb5a56e03097385a49
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