Can ABNs be given on a routine basis?
Routinely issued ABNs are permitted in the following situations: • For items and services never covered, under any circumstances, as not reasonable and necessary under §1862(a)(1) of the Act (e.g., acupuncture). • For items and services which Medicare considers to be experimental (e.g., “Research Use Only” and “Investigational Use Only” laboratory tests) and, therefore, not reasonable and necessary under §1862(a)(1) of the Act. • Any item or service for which Medicare has established a statutory or regulatory frequency limitation on coverage, or a frequency limitation on coverage on the basis of a national coverage decision or on the basis of Local Coverage Determination (LCD), because all or virtually all beneficiaries may be at risk of having their claims denied in those circumstances. The ABN must state that “Medicare does not pay for this item or service more often than [frequency limit]. • For DMEPOS that likely will be denied because the supplier has no supplier number or because
Routinely issued ABNs are permitted in the following situations: • For items and services never covered, under any circumstances, as not reasonable and necessary under §1862(a)(1) of the Act (e.g., acupuncture). • For items and services which Medicare considers to be experimental (e.g., “Research Use Only” and “Investigational Use Only” laboratory tests) and, therefore, not reasonable and necessary under §1862(a)(1) of the Act. • Any item or service for which Medicare has established a statutory or regulatory frequency limitation on coverage, or a frequency limitation on coverage on the basis of a national coverage decision or on the basis of Local Coverage Determination (LCD), because all or virtually all beneficiaries may be at risk of having their claims denied in those circumstances. The ABN must state that “Medicare does not pay for this item or service more often than [frequency limit]. • For DMEPOS that likely will be denied because the supplier has no supplier number or because
