Overview
The ABN form, officially CMS-R-131, is the standardized notice for applicable Original Medicare Fee-for-Service financial-liability situations. Teams should retrieve the current OMB-approved English or Spanish form and instructions from the CMS Fee-for-Service ABN page rather than hard-code an expiration date or rely on a locally stored old version. Medicare Advantage and commercial payer workflows require their own plan- or payer-specific paths.
The form captures the notifier and beneficiary, the specific item or service, the reason Medicare is expected not to pay, and a good-faith estimated cost. It presents three beneficiary options. Option 1 asks for the item or service and submission of a Medicare claim; Option 2 asks for the item or service without submitting a Medicare claim; Option 3 declines the item or service. The beneficiary or authorized representative—not software or laboratory staff—selects the option and signs and dates the notice.
Completion alone is not enough. The notice must be delivered far enough in advance for a capable recipient to understand the information, ask questions, and make a meaningful choice. A generic statement that Medicare might not pay, a blanket form used for every patient, a blank or pre-signed form, or a notice delivered after testing does not create a reliable liability-transfer workflow. Notices should not be obtained in a medical emergency or under great duress. Missing or conflicting clinical facts must be queried or escalated rather than manufactured.
Electronic issuance and digitally captured signatures are permitted. When a beneficiary views the ABN electronically, the workflow must offer paper issuance if preferred and should give the beneficiary a paper copy of the signed notice. Delivery method, explanation, option selection, signature, date, and any refusal annotation should remain retrievable. If the notifier is not the laboratory that ultimately bills Medicare, the signed copy should be sent to the billing entity.
The general retention period in CMS guidance is five years from discharge or completion of delivery of care when no other state-law requirement applies. A longer applicable requirement may control. For repetitive testing, one notice may describe an extended course only when the affected services and duration are identified and the care, health status, and coverage guidance remain unchanged; a changed service or policy requires new review. Modifier and claim treatment must be validated from the actual notice status. The ABN documents advance notice and patient choice—it does not itself constitute Medicare's coverage decision. Reviewers should revalidate the form version and cited coverage source whenever CMS or the applicable policy changes.
Worked example
Before collecting a specimen, a laboratory reviewer confirms that an ordered test is expected to fall outside a current Original Medicare frequency limit. Staff use the current CMS-R-131 form to name the test, explain the frequency-based expected-denial reason, and provide a good-faith estimate. The beneficiary reviews three unselected options, chooses one, and signs and dates the notice; the lab preserves the signed copy and supporting policy evidence.
Frequently asked questions — ABN Form (CMS-R-131)
Where do we get the current ABN form?
CMS publishes the form on the Beneficiary Notices Initiative page (cms.gov/Medicare/Medicare-General-Information/BNI). Using the current English and Spanish versions is required; older versions are periodically retired.
Can we use electronic ABN delivery?
Yes. The beneficiary must be able to review the full notice before signing, must be offered paper issuance as an alternative, and should receive a paper copy of the signed ABN. The electronic record should preserve the same content, choice, signature, date, delivery, and retention evidence.
How specific does the 'reason Medicare may not pay' language need to be?
Specific enough that a reasonable person could understand why Medicare is expected to deny. Generic statements like 'Medicare may not cover this' are considered invalid. Example of adequate language: 'Medicare only covers this test for diagnoses listed in LCD L36692; your current diagnosis is not on that list.'
Must the ABN be in the beneficiary's preferred language?
Delivery in a language the beneficiary understands is a best practice and, under Section 1557 of the ACA, often a requirement for recipients of federal funding. CMS publishes English and Spanish versions; many providers use translators for other languages.
Disclaimer
This glossary entry is operational reference for revenue-cycle and medical-billing professionals. It is not legal, clinical, or contractual advice. Industry benchmarks cite named public sources where available; always verify against the current guidance from the authority body before relying on a number in a contract, policy, or compliance filing.