Advance Beneficiary Notice (ABN)

The Advance Beneficiary Notice of Non-Coverage (ABN), CMS-R-131, is a standardized notice that providers give to Original Medicare patients before a service that Medicare may not cover. It explains the item or service, the reason coverage may be denied, and the estimated cost, so the patient can choose whether to accept financial responsibility. This template is a starting point, so confirm wording with your own compliance or legal counsel.

What does an ABN include?

CMS requires the ABN to use the official CMS-R-131 form and to keep its numbered blanks and option box intact. A complete ABN generally captures the following.

Notifier and patient details. The provider or supplier name, address, and contact information, plus the patient name and an identification number that is not the Medicare number.
Items or services (blank D). A description of the specific items or services that Medicare may not pay for.
Reason Medicare may not pay (blank E). A plain-language explanation of why coverage may be denied, such as a service Medicare considers not medically necessary.
Estimated cost (blank F). A good-faith estimate of what the patient may owe for the listed items or services.
Options box (blank G). Three choices letting the patient decide whether to receive the service and whether to have a claim submitted to Medicare.
Additional information. Any clarifying notes the provider wants to add, such as insurance or appeal details.
Signature and date. The patient or representative signs and dates the notice to confirm they understood the options before the service.

How to administer the ABN

Deliver the ABN far enough ahead of the item or service that the patient has time to consider their options, not at the moment of care.
Complete the items, reason, and estimated cost blanks so the patient sees exactly what may not be covered and the likely charge.
Review the notice with the patient, answer questions, and make sure they choose one option in the options box.
Have the patient or their representative sign and date the ABN before the service is provided.
Give the patient a copy and retain the signed notice according to your record-retention policy.
Issue a fresh ABN for returning patients whenever a new service may fall outside Medicare coverage.

Who uses the ABN?

Physician and specialist offices that treat Original Medicare patients and order services coverage may deny.
Laboratories and imaging centers performing tests that may exceed Medicare frequency or medical-necessity limits.
Therapy and outpatient clinics providing physical, occupational, or speech therapy that may not be covered.
Suppliers and billing staff who need documented patient consent to bill for non-covered items.

Digital vs paper ABN

Paper	Zentake digital
Handwritten blanks can be incomplete or illegible	Required fields guide staff to a complete notice
Filled out at the front desk, adding wait time	Prepared and reviewed before the visit
Ink signature on a printed form	Secure e-signature captured on any device
Stored in paper files or scanned later	Encrypted, HIPAA-compliant storage
Reissuing means reprinting each time	Reissue or update in a few clicks
Staff re-key details by hand	Less manual data entry for staff

How Zentake helps with the ABN

E-signatures. Capture a legally sound patient signature on the notice with electronic signatures on phone, tablet, or computer.
Custom form builder. Match the CMS-R-131 fields to your workflow with a custom form builder.
Before the visit. Send the notice ahead of time so patients can read the options and decide without pressure at check-in.
HIPAA compliant. Every form is encrypted and backed by a signed BAA on every plan.
In-clinic tablets. Patients who did not complete the notice ahead of time can finish it on an in-clinic tablet.

References

The ABN is issued under CMS Fee-for-Service beneficiary notice rules using the mandatory Form CMS-R-131. See the CMS Fee-for-Service ABN page for the current form and instructions.

Detailed delivery, completion, and financial-liability requirements appear in the Medicare Claims Processing Manual, Chapter 30. Requirements and estimates can vary by service and setting, so verify specifics with your Medicare Administrative Contractor and compliance team. See the CMS manual instructions.

Last updated: August 2026

Advance Beneficiary Notice of Non-Coverage questions, answered.

What is an ABN?

An ABN, or Advance Beneficiary Notice of Non-Coverage (Form CMS-R-131), is a written notice a provider gives an Original Medicare patient before a service Medicare may not cover. It lists the service, the reason for possible denial, and the estimated cost so the patient can decide whether to accept responsibility for payment.

When is an ABN required?

An ABN is required when a provider believes Medicare will likely deny an item or service that is usually covered, often because it is not considered medically necessary or exceeds coverage limits. Delivering it in advance lets the patient choose whether to proceed and preserves the provider's ability to bill the patient.

What happens if a patient refuses to sign?

If a patient refuses to sign the ABN, the provider should note the refusal on the notice, ideally with a witness. Depending on the situation, the provider may decide whether to furnish the service. Refusing to sign does not remove the patient's potential financial responsibility for non-covered care.

Does an ABN apply to Medicare Advantage plans?

The CMS-R-131 ABN is designed for Original Medicare, also called Fee-for-Service Medicare. Medicare Advantage plans use their own denial and appeal notices instead. Confirm which notice applies to your patient's coverage, since using the wrong form can affect your ability to bill.

How long should signed ABNs be kept?

Providers generally retain signed ABNs for at least the period required by Medicare and their own record-retention policies, commonly several years. Keeping the signed notice supports billing and any later coverage or appeal questions. Confirm the exact retention period with your compliance team, since requirements vary.

Is this ABN template legal advice?

No. This template is a starting point to help practices collect the information a standard ABN covers. It is not legal or compliance advice. Always use the current official CMS-R-131 form and confirm your wording and process with your own billing, compliance, or legal counsel.