US · guidance
CMS Pub. 100-04, ch. 32, § 190.4
Advance Beneficiary Notice and Hospital Issued Notice of Noncoverage
Information
(Rev. 1206; Issued: 03-16-07; Effective: December 19, 2006; Implementation: 04-02-07)
If this service is not reasonable and necessary under 1862(a)(1)(A) of the Act (falls outside the scope of the
revised NCD found in Pub. 100-03, chapter 1, section 110.4), contractors shall advise physicians and/or
hospital outpatient departments, including critical access hospitals (CAHs), that they will be held liable for
charges unless the physician and/or hospital has the beneficiary sign an Advance Beneficiary Notice in
advance of providing the service.
If this service is provided to a hospital inpatient, including CAHs, for a reason unrelated to the admission
(outside of the bundled payment) contractors shall advise hospitals billing for inpatient services that they will
be held liable for charges unless the hospital has the beneficiary sign a Hospital Issued Notice of Noncoverage
letter 11 in advance of providing the service.
History
(Rev. 1206; Issued: 03-16-07; Effective: December 19, 2006; Implementation: 04-02-07)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
e9ce4c35b1fc082241347c09712ef4fc7efe746e48d9b2140b76f847dda1466c
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