FFS SNF ABN

What's New

08/28/2024: With the help of our contractors, we revised the SNF ABN, Form CMS-10055, and the form instructions.  The SNF ABN form and instructions are located in the download section and are available for immediate use, but will be mandatory for use on 10/31/2024.    

Skilled Nursing Facilities (SNFs) must issue a notice to Original Medicare (fee for service - FFS) beneficiaries in order to transfer potential financial liability before the SNF provides:

• an item or service that is usually paid for by Medicare, but may not be paid for in this particular instance because it is not medically reasonable and necessary, or
• custodial care.

For Part A items and services: SNFs use the SNF ABN as the liability notice.

For Part B items and services: SNFs use the Advance Beneficiary Notice of Non-coverage (ABN), Form CMS-R-131. The ABN and information on this notice can be found at /Medicare/Medicare-General-Information/BNI/ABN.

To download the SNF ABN and accompanying instructions, please click on the appropriate link below.

Questions?

Questions regarding the SNF ABN or ABN can be submitted at: https://appeals.lmi.org/