CMS Pub. 100-04, ch. 30, § 50.2.1

ABNs are not required for care that is either statutorily excluded from coverage under

Medicare (i.e. care that is never covered) or most care that fails to meet a technical

benefit requirement (i.e. lacks required certification). However, CMS strongly encourage

healthcare providers and suppliers to issue the ABN for care that is never covered such

as:

• Care that fails to meet the definition of a Medicare benefit as defined in §1861 of the

Social Security Act;

• Care that is explicitly excluded from coverage under §1862 of the Social

Security Act. Examples include:

° Services for which there is no legal obligation to pay;

° Services paid for by a government entity other than Medicare (this

exclusion does not include services paid for by Medicaid on behalf of dual-eligibles);

° Services required as a result of war;

° Personal comfort items;

° Routine eye care;

° Dental care; and

° Routine foot care.

When the ABN is used in this way it serves as a courtesy to the beneficiary in

forewarning him/her of impending financial obligation. The beneficiary should not be

asked to choose an option box or sign the notice. The healthcare provider or supplier is

not required to adhere to the issuance guidelines for the ABN.

NOTE: Certain DME items/services that fail to meet a technical requirement may require

an ABN as outlined in the mandatory use section above.