Optional ABN Uses

50.2.1 - Optional ABN Uses (Rev. 10862; Issued: 07-14-21; Effective: 10-14-21; Implementation: 10-14-21) 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.