Updated October 19, 2026. Quick answer: Form CMS-R-131 is the Advance Beneficiary Notice of Non-coverage, usually called the ABN. A provider gives it to you before care Medicare is not likely to cover, so you can decide whether to get it and accept the cost. You pick one of three options. Option 1 asks Medicare to be billed and keeps your right to appeal. Option 2 does not bill Medicare and you cannot appeal. Option 3 declines the care.
Quick reference
| Item | As printed on the form or its instructions |
|---|---|
| Option 1 | Get the care; bill Medicare for an official decision; you can appeal the decision |
| Option 2 | Get the care; do not bill Medicare; you pay and cannot appeal |
| Option 3 | Do not get the care; you owe nothing and cannot appeal |
| Who delivers it | The provider or supplier, before the item or service |
| Never required | In emergency situations |
| Appeal window after Option 1 | 120 days from receipt of the decision (calendar days) |
| Receipt presumed | 5 days after the date of the notice |
| Late appeal | Possible for good cause after the 120 days |
| Cost field | A good faith estimate for each item listed |
| Your signature means | You received and understand the notice |
| Help | 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048 |
What the notice says
The notice opens in plain terms: “Medicare doesn’t pay for everything, even some care you or your health care provider think you need.” It continues “If Medicare doesn’t pay, you may have to pay.” The provider fills in the item, test, service or care, the reason Medicare may not pay, and the estimated cost. The form adds “This notice gives our opinion, not an official Medicare decision.” An ABN is a warning about money. It is not a denial.
The three options
The form says to “Choose ONE option below.” The option you tick decides your appeal rights, so it is the line to read slowly.
Option 1 keeps the door open: “I understand that if Medicare doesn’t pay, I’m responsible to pay, but I can appeal to Medicare by following the directions on the MSN.” The MSN is the Medicare Summary Notice that comes back with the official payment decision. If Medicare does pay, the provider refunds what you paid, minus co-pays or deductibles.
The decision you appeal is the official payment decision. The regulation sets the window for the first level of appeal: “any request for redetermination must be filed within 120 calendar days from the date a party receives the notice of the initial determination.” Receipt is presumed 5 days after the date on the notice. That request is made on Form CMS-20027.
Option 2 closes it: “I understand that I can’t appeal, since Medicare isn’t billed.” Option 3 is declining the care: “I understand I’m not responsible for payment and I can’t appeal to see if Medicare would pay.” If you want a chance to have Medicare decide, Option 1 is the only one that creates a decision you can take to a redetermination request.
What the provider must do
The instructions to providers set the rules you can hold them to. A notifier must “Deliver the ABN to the patient or their representative before providing the items or services;” review it with you and answer questions before you sign, and deliver it “far enough in advance that the patient or representative has time to consider the options and make an informed choice;” They also state that “ABNs are never required in emergency situations.”
On cost, the instructions require a real attempt: an estimate that is too high is generally acceptable, because “the patient wouldn’t be harmed if actual costs were less.” The notice is not supposed to carry your Medicare number: “Medicare beneficiary identifiers (MBIs), or Social Security numbers should not appear on the notice.”
Sign only after you understand it
The signature line reads as an acknowledgment, not a promise to pay anything you did not choose. The form says “Signing below means you received and understand this notice.” The instructions note that the ABN may also warn about items Medicare never covers, and that in that use “the patient doesn’t need to choose an option box or sign the notice.”
If you are on both Medicare and Medicaid, the instructions carry special guidance, including that dually eligible patients be told to check Option 1 so a claim is sent for Medicare review. Ask the provider to explain it before you sign. Our guide to Medicare notices lists the other letters that carry a deadline.
The edition read for this page is Form CMS-R-131 (Exp. 03/31/2029) 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
- Ticking Option 2 to avoid a Medicare denial. The form says you then pay and cannot appeal, because Medicare is never billed.
- Signing a blank ABN. The item, reason and estimated cost are what make it a notice at all.
- Treating an ABN as proof that Medicare will deny the claim. The form calls it the provider’s opinion, not an official decision.
- Being asked to sign in an emergency. The instructions say an ABN is never required in emergency situations.
Related: Form CMS-20027, Medicare notices, and Social Security and Medicare forms.
Sources
- Form CMS-R-131 (Exp. 03/31/2029), Advance Beneficiary Notice of Non-coverage (ABN): https://www.cms.gov/medicare/medicare-general-information/bni/abn
- Form Instructions, Advance Beneficiary Notice of Non-coverage (ABN), CMS-R-131: https://www.cms.gov/medicare/medicare-general-information/bni/downloads/abn-form-instructions.pdf
- 42 CFR 405.942, Time frame for filing a request for a redetermination (eCFR, read 2026-10-19): https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-405/subpart-I/section-405.942
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.