Updated October 19, 2026. Quick answer: Form CMS-10123 is the Notice of Medicare Non-Coverage (NOMNC). A skilled nursing facility, home health agency, rehabilitation facility, hospice or Medicare Advantage plan gives it to you at least two calendar days before covered services end. To appeal, you must ask your Quality Improvement Organization no later than noon of the day before the end date printed on the notice. Signing the notice only shows you received it.
Quick reference
| Item | As printed on the form or its instructions |
|---|---|
| What the form is | Notice that Medicare coverage of current services will end on a stated date |
| Services covered | Skilled nursing, home health, comprehensive outpatient rehabilitation, hospice |
| Delivered | At least 2 days before coverage ends (calendar days, not 48 hours) |
| Appeal deadline | No later than noon, 1 day before the end date |
| Appeal goes to | Your Quality Improvement Organization (QIO) |
| QIO decision | Generally no later than 2 days after the end date; by the end date for plan members |
| Your signature | Shows you received and understand the notice |
| Follow-up notice | Detailed Explanation of Non-coverage, Form CMS-10124 |
Who gets this notice, and when
The instructions say a provider or plan “must deliver a completed copy of this notice to beneficiaries/enrollees receiving covered skilled nursing, home health, comprehensive outpatient rehabilitation facility, and hospice services”. Timing is part of the rule: “The NOMNC must be delivered at least two calendar days before Medicare covered services end or the second to last day of service if care is not being provided daily.”
The instructions add a clarification that matters when counting: “The two-day advance requirement is not a 48-hour requirement.” For the rule that catches people, the noon cutoff, read our page on the noon deadline for the Notice of Medicare Non-Coverage. This page covers the form itself.
What the notice says
The provider’s contact information sits at the top, followed by the patient name and number and the headline: “Medicare Coverage of Your Current {insert type} Services Will End on {insert effective date}” The braces are blanks the provider fills in with the kind of service and the real date. The notice then states the reason: “Your provider and/or health plan determined that Medicare probably won’t pay for your {insert type} services after the above date.”
The patient number must not be your Medicare number. The instructions say “The beneficiary’s/enrollee’s MBI number must not be used.”
Your right to an immediate appeal
The notice describes the appeal in four short claims. “You have the right to appeal the decision to end Medicare coverage of your services.” The review is independent and “Your services will continue during the appeal.” The reviewer asks for your opinion, and “You don’t have to prepare anything in writing, but you have the right to do so.”
The deadline is on the page: “You must ask for a timely appeal no later than noon of the day before the above date.” You ask your Quality Improvement Organization, defined in the notice as the independent reviewer authorized by Medicare, using the toll-free number the provider must print. The notice also says “If you miss the deadline to ask for an immediate appeal, you may still have appeal rights.” If you do appeal, you get the Detailed Explanation of Non-coverage next.
What the signature means, and what happens after
The signature statement is narrow: “I’ve been notified that coverage of my services will end on the date on this notice, and that I can appeal this decision by contacting my QIO.” The statement itself preserves your right to appeal, and the signature line is for the patient or a representative.
On timing of the answer the notice says “The QIO will let you know its decision as soon as possible, generally no later than two days after the effective date above.” For plan members the QIO generally decides by the effective date. If the reviewer agrees coverage should end, “neither Medicare nor your plan will pay for these services after the above date.” Stopping by the date avoids financial liability. For the stay-length rules behind these notices see Medicare’s 100 days of rehab.
The edition read for this page is Form CMS-10123-NOMNC (expires 11/30/2027) as the agency served it on 2026-10-19. Check the edition printed on the copy you use, because a later edition can change the questions, the mailing instructions and the evidence asked for.
Common mistakes
- Waiting until the end date to call. The immediate appeal must be requested no later than noon of the day before it.
- Reading the two-day rule as 48 hours. The instructions say it is not a 48-hour requirement.
- Refusing to sign because you disagree. The signature only acknowledges you received the notice and were told you can appeal.
- Giving the provider your Medicare number as the patient number. The instructions say it must not be used.
Related: the noon deadline explained, Form CMS-10124, Medicare’s 100 days of rehab, and Social Security and Medicare forms.
Sources
- Form CMS-10123-NOMNC (Exp. 11/30/2027), Notice of Medicare Non-Coverage: https://www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative
- Notice Instructions for the Notice of Medicare Non-Coverage (NOMNC), CMS-10123: https://www.cms.gov/files/document/notice-medicare-non-coverage-instructions-eff-jan-2025.pdf
Read from the Social Security Administration and Centers for Medicare and Medicaid Services documents linked above on October 19, 2026. General information, not legal or benefits advice. Your own facts decide the outcome, and Social Security at 1-800-772-1213 is the right place to confirm anything consequential.