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Circumstances in which the healthcare provider must give an ABN to the patient.
The following provisions necessitate delivery of the ABN:
Services not considered reasonable and necessary (Most Common for PT and OT)
Medical equipment and/or supplies denied in advance
Hospice patient who is not terminally ill
Home health services requirements are not met – not confined to the home or no need for intermittent skilled nursing care
Personalized prevention plan services
When a noncontract supplier furnishes an item included in the Durable Medical Equipment, Prosthetic, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) for a Competitive Bidding Area (CBA)
When Medicare considers an item or service experimental (e.g., a “Research Use Only” or “Investigational Use Only”