HHZ Respiratory Review

Advance Beneficiary Notice (ABN) for CPAP and oxygen

1 min read By HHZ Editorial Next review

An ABN (Form CMS-R-131) is a supplier's written warning that it expects Original Medicare won't pay for an item, with the estimated cost and reason. It isn't a Medicare denial. Choosing Option 1 gets you the item and sends a claim to Medicare, so you can appeal; if Medicare pays, the supplier refunds you minus copays or deductibles. Options 2 and 3 don't send a claim and can't be appealed. Sources: Medicare.gov and CMS, checked 13 October 2026.

Sources: Medicare.gov Your protections; CMS FFS ABN and ABN form instructions, checked 13 October 2026.

The 3 options

OptionYou get the item?Claim sent to Medicare?Can you appeal?If Medicare pays
1YesYesYesSupplier refunds you, minus copays or deductibles*
2YesNoNoNot applicable
3NoNoNoNot applicable

*CMS lets suppliers that don’t accept assignment strike the refund sentence and add a statement that you’re responsible for their charge.

When you might see one for CPAP or oxygen

The ABN lists the reason the supplier expects Medicare won’t pay. For CPAP and oxygen, check the reason against Medicare’s rules: for example, supplies more often than the usual limits (CPAP supplies schedule), or coverage criteria not documented (Medicare CPAP rules, Medicare oxygen coverage).

What to do

  1. Read the reason and the estimated cost.
  2. Ask your doctor whether documentation could fix the problem.
  3. If you want the item and the right to appeal, choose Option 1.
  4. Keep a copy, then watch your Medicare Summary Notice and appeal if needed.

Verdict

An ABN is a cost warning, not a final decision. Option 1 keeps your options open.

Related: Medicare CPAP coverage, Medicare oxygen coverage, DME assignment explained.

Frequently asked questions

What is an ABN?
An Advance Beneficiary Notice of Non-coverage (Form CMS-R-131) is a written notice from an Original Medicare provider or supplier that it expects Medicare won't pay for an item, with the estimated cost and reason.
Is an ABN a Medicare denial?
No. Medicare.gov says it isn't an official denial; you can appeal if a claim is submitted and Medicare denies payment.
Which option should I choose?
Option 1 gets you the item and has the claim sent to Medicare, so you keep your right to appeal. Options 2 and 3 don't send a claim, so you can't appeal.
What if the supplier doesn't accept assignment?
CMS's ABN instructions let non-participating suppliers strike the refund sentence in Option 1 and add a statement that you're responsible for the supplier's charge.
Do I get an ABN for items Medicare never covers?
Medicare.gov says an ABN isn't required for items or services that Medicare never covers.

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