Anesthesia Coding Alert

Question: Does Medicare have any guidelines regarding having a patient pay for an anesthesia service that may not be medically necessary?

New York Subscriber

Answer: Yes. Providers may issue an Advance Beneficiary Notice of Noncoverage (ABN), form CMS-R-131, to Medicare fee-for-service (FFS) beneficiaries when they expect Medicare will not pay for an item or service. “The ABN is issued in order to transfer potential financial liability to the Medicare beneficiary in certain instances,” according to the Centers for Medicare & Medicaid Services (CMS).

In fact, CMS has updated the ABN form. As of April 4, 2023, “The ABN, Form CMS-R-131, and form instructions have been approved by the Office of Management and Budget (OMB) for renewal. The use of the renewed form with the expiration date of 01/31/2026 will be mandatory on 6/30/23. You may continue to use the ABN form with the expiration date of 6/30/23 until the renewed form (expiration date 01/31/2026) becomes mandatory on 6/30/23.”

Make sure to download the instructions, as the form must be completed properly and prior to providing the anesthesia service to the patient.

Resource: Review CMS guidance on ABNs at www.cms.gov/medicare/medicare-general-information/bni/abn.