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Circumstances in which the healthcare provider must give an ABN to the patient.
When an item or service is not reasonable and necessary under Medicare Program standards. Common reasons Medicare denies an item or service as not medically reasonable and necessary include care that is:
When custodial care is given:
Before caring for a beneficiary who is not terminally ill (hospice providers).
Before caring for a beneficiary who is not confined to the home or does not need intermittent skilled nursing care (home health providers).
Before furnishing a preventive service usually covered but Medicare will not cover in this instance because of frequency limitations.
Before furnishing an item or service Medicare will not pay because (durable medical equipment, prosthetics, orthotics, and supplies [DMEPOS] suppliers):