The ABN must clearly identify the service/procedure the neurologist plans to provide and state why Medicare may not provide coverage. The ABN affects only those services/procedures you've specifically listed. You should not give an ABN to a beneficiary if you have no specific, identifiable reason to believe Medicare will not pay. In all cases, you should provide the patient with a completed and signed copy of the ABN for his records.
Helpful hint: To obtain a standardized, sample ABN, visit the CMS Web site www.cms.gov and use the "search" function to locate form "CMS-R-131-G."