Billing / Fees / Insurance

Advance Beneficiary Notice (ABN) Update

Updated Form Effective Through March 31, 2029

Samuel A. Collins

WHAT YOU NEED TO KNOW

The Centers for Medicare & Medicaid Services (CMS) released an updated Advance Beneficiary Notice (ABN) to replace the prior version that expired earlier this year.
The new version features a cleaner design, reduced clutter and updated language throughout several sections.
An ABN must be issued when a Medicare-covered service (spinal CMT in chiropractic) is expected to be denied.

The Centers for Medicare & Medicaid Services (CMS) released an updated Advance Beneficiary Notice (ABN) to replace the prior version that expired earlier this year. The updated form is valid through March 31, 2029.

The new version features a cleaner design, reduced clutter and updated language throughout several sections. While the format has improved, the requirements and patient responsibilities remain unchanged. (Download the new form here.)

When an ABN Is Required

An ABN must be issued when a Medicare-covered service (spinal CMT in chiropractic) is expected to be denied for reasons such as the following:

Service is not medically necessary for the diagnosis or condition
Service is experimental or investigational
Service exceeds frequency or duration limits for the diagnosis

When an ABN is properly executed for spinal CMT, the claim should include modifier GA, indicating the patient has been notified and accepts financial responsibility.

IMPORTANT USE RULES FOR ADVANCE BENEFICIARY NOTICE

ABNs may be used for both covered and excluded services.
Do not combine excluded services and non-covered spinal CMT on the same ABN.
If using ABNs for both scenarios, they must be issued separately.

Use of ABNs for Non-Covered (Excluded) Services

Although ABNs are intended for covered services that may be denied, they may also be used for statutorily excluded services (which includes most services in a chiropractic office aside from spinal CMT). Examples of excluded services:

Exams
Therapies (e.g., massage, exercise)
Adjunctive procedures

However, using ABNs in this context can create confusion for patients, since Medicare never covers these services.

Best Practice for Statutory Excluded Services

Many offices choose to use a Medicare financial policy or agreement instead of an ABN. This document clearly explains what Medicare does and does not cover; that certain services are never covered; and that the patient is financially responsible. This approach is often more straightforward and reduces misunderstandings.

Sam’s Best Practice

Use a financial policy/agreement for excluded services.
Reserve the ABN for spinal CMT when Medicare coverage criteria are not met.

This approach minimizes confusion, strengthens compliance and aligns with how Medicare reviewers interpret proper ABN usage.

Editor’s Note: Have a billing question? Submit it via email to Sam at sam@hjrossnetwork.com. Your question may be the subject of a future column.

June 2026