CMS Releases Updated Advance Beneficiary Notice (ABN): Start Using It Immediately
The Centers for Medicare & Medicaid Services (CMS) has released an updated version of the Advance Beneficiary Notice of Non-coverage (ABN), Form CMS-R-131. The Illinois Chiropractic Society recommends that chiropractic physicians and their staff begin using the new version immediately. CMS has allowed a transition period, but all practices must begin using the updated form no later than May 12, 2026.
The situations that require an ABN and the overall purpose of the notice have not changed. In fact, the updated version slightly reduces the amount of information providers must repeat within the form, making it easier to complete correctly.
Advertisement
Access the new form here.
What Changed
Most of the revisions focus on improving readability and eliminating duplication within the form.
The most meaningful operational change is that providers no longer need to repeat the item, test, service, or care being addressed in multiple sections of the form.
Under the previous version, the options referenced the care in question using “(D) listed above,” which required providers to carefully match language across several parts of the notice. The updated form simplifies this structure.
Key differences include:
- Services no longer need to be referenced in the options section. The options now refer generally to “the item, test, service or care listed above.”
- Services do not need to be repeated in the introductory notice language.
- Services do not need to be repeated in the “What to do now” section.
Instead, the item, test, service, or care expected to be denied only needs to be listed clearly in the table, along with the reason Medicare may not pay and the estimated cost.
These changes reduce the risk of small documentation inconsistencies that previously could invalidate the notice.
What Did Not Change
The underlying rules for ABN use remain the same.
Providers must still issue an ABN before delivering the statutorily covered care (currently spinal adjustments or 98940, 98941, or 98942) that Medicare is expected to deny (i.e., maintenance care that is not reimbursable). The notice must be reviewed with the patient or their representative, and the patient must select one of the available options and sign the form.
The three options for the patient remain the same in purpose:
- Receive the item, test, service, or care, and have Medicare billed for a coverage decision
- Receive the item, test, service, or care, but do not bill Medicare
- Decline the item, test, service, or care
The ABN continues to function as the mechanism that allows providers to transfer potential financial liability to the beneficiary when Medicare is expected to deny coverage.
ABN Best Practices Reminder
ICS members also have access to a companion resource that includes examples of properly completed ABN forms for several common scenarios, including:
- A typical Medicare beneficiary
- A Qualified Medicare Beneficiary (QMB)
- A situation involving a non-participating provider
These examples are available in a single PDF to help offices understand how the notice should be completed in real-world situations. Special thanks to Dr. Mario Fucinari for making these examples available to ICS members.
While the form itself has only minor revisions, ABN use remains a frequent compliance issue in Medicare audits.
The Illinois Chiropractic Society has produced a short video explaining best practices for when an ABN should be issued and how chiropractic offices should approach ABN workflows. Members are encouraged to review that resource with their staff to ensure their procedures are consistent with Medicare expectations. Click here for the video.
Action for Chiropractic Offices
Offices should update their systems and forms now to ensure the revised ABN is in place well before the transition deadline. This includes replacing stored templates in practice management systems or EHR platforms and updating printed copies used by front desk or billing staff.
Using the correct form before the May 12, 2026 deadline will help prevent claim disputes and avoid complications when attempting to transfer financial liability to a Medicare beneficiary.
Downloads
ABN Large Print
ABN From – English
ABN Form – Spanish
ABN From Example Set
