US · guidance
CMS Pub. 100-04, ch. 30, § 50.13
ABN Standards for Upgraded Durable Medical Equipment,
Prosthetics, Orthotics, and Supplies (DMEPOS)
(Rev. 10862; Issued: 07-14-21; Effective: 10-14-21; Implementation: 10-14-21)
Notifiers must give an ABN before a beneficiary receives a Medicare covered item
containing upgrade components that are not medically reasonable and necessary and not
paid for by the supplier. DME upgrades involve situations in which the upgraded item or
component has a different Heath Insurance Common Procedure Coding System (HCPCS)
code than the item that will be covered by Medicare. Please refer to Chapter 20, Section
120 in this manual for information on billing procedures for ABN upgrades.
ABNs cannot be used to charge beneficiaries for premium quality services described as
“excess components.” Similarly, ABNs cannot be used to shift liability for an item or
service that is described on the ABN as being “better” or “higher quality” on an ABN but
do not exceed the HCPCS code description.
History
(Rev. 10862; Issued: 07-14-21; Effective: 10-14-21; Implementation: 10-14-21)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
39428b761f98922ab11e08deec3dbd2a39b9d4ea87bea116063b7af47a0120d9
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.