Revised Advance Beneficiary Notice Form

Required On June30, 2023

CMSissued an update to the Advance Beneficiary Notice (ABN) Form, CMS-R-131, which will be mandatory beginning June 30, 2023. The expiration date of the new form is 01/31/2026. The updated ABN form, in both PDFand Microsoft Word versions with instructions in English and Spanish and in normal or large print, are available for download:

The CMSsite provides a separate link to download ABN Form Instructions Chapter 30 of the Medicare Claims Processing Manual beginning Section 50.3 also provides information and instructions on the requirements for completing and issuing an Advance Beneficiary Notice