CMS Pub. 100-04, ch. 30, § 50.14

Program (CBP)

(Rev. 10862; Issued: 07-14-21; Effective: 10-14-21; Implementation: 10-14-21)

Section 1862 (a)(17) of the Act excludes Medicare payment for CBP items/ services that

are provided by a non-contract supplier in a Competitive Bidding Area (CBA) except in

special circumstances. A non-contracted supplier is permitted to provide a beneficiary

with an item or service listed in the CBP when the supplier properly issues an ABN prior

to delivery of the item or service per 42 CFR §414.408(e)(3)(ii). In order for the ABN to

be considered valid when issued under these circumstances, the reason that Medicare

may not pay must be clearly and fully explained on the ABN that is signed by the

beneficiary.

To be a valid ABN, the beneficiary must understand the meaning of the notice. Suppliers

must explain to the beneficiary that Medicare will pay for the item if it is obtained from a

different supplier in the area. While some suppliers may be reluctant to direct

beneficiaries to a specific contracted supplier, the non-contracted supplier should at least

direct the beneficiary to 1-800 –MEDICARE to find a local contracted supplier at the

beneficiary’s request.