SNF ABN (Form CMS-10055): When to Issue, Deliver, and Correct

The SNF ABN, Form CMS-10055, is the written notice a skilled nursing facility gives an Original Medicare resident before providing care the facility believes Medicare will stop paying for. If the notice is delivered properly and completed correctly, financial responsibility can shift to the resident. If it isn’t, the facility usually cannot bill the resident for the disputed care at all.¹

When the Facility Must Issue It

A skilled nursing facility is required to give the SNF ABN to an Original Medicare beneficiary before providing Part A care that Medicare usually covers but may not pay for in this particular case.² Two situations trigger the notice:

The care is no longer medically reasonable and necessary. A common example is a resident who has plateaued in physical therapy, where continued treatment would not produce meaningful improvement.
The care has become custodial, meaning it is now help with everyday activities such as bathing, dressing, or eating. Medicare Part A does not pay for custodial care in a skilled nursing facility.

The form only applies to services under the SNF Prospective Payment System (Medicare Part A), and only when the resident intends to keep staying at the facility. Residents enrolled in a Medicare Advantage plan receive different notices governed by their plan’s procedures, not this form. If you are unsure which type of Medicare you have, check your Medicare card or call 1-800-MEDICARE.³

Not the Same as a NOMNC

The SNF ABN is easy to confuse with the Notice of Medicare Non-Coverage, but they do different things. A NOMNC is issued when the facility is ending all Medicare-covered services entirely, and it gives the resident the right to an expedited review by a Beneficiary and Family Centered Care Quality Improvement Organization.⁴ The SNF ABN targets specific items or services the facility expects Medicare to deny, usually because the care is no longer skilled. A resident can receive both notices during the same stay.

Filling Out the Form

Download the current fillable PDF directly from CMS.⁵ Using an outdated version is grounds for invalidation.

Header

The blank above the title is for the facility’s name, address, and phone number at a minimum. Add a TTY number when needed to meet a resident’s communication needs.² Enter the beneficiary’s first and last name, and include a middle initial if one appears on the Medicare card. The identification number field is optional; the notice is valid without it, though facilities often insert a medical record or tracking number to link the notice to a claim.

Body

The body has four items the facility fills in:

The “beginning on” date, which is the date the resident may become responsible for paying.
The care checkboxes: Physical Therapy, Occupational Therapy, Daily Skilled Nursing Care, or Other. If “Other” is checked, write in the exact service that had been provided.
The reason Medicare may not pay. Cite the applicable coverage guideline and explain, in language the resident can understand, why their condition does not meet it. The instructions give this sample: “You need only assistive or supportive care. You don’t require daily skilled care by a professional nurse or therapist.”⁶
A good-faith cost estimate. It can be a total, a daily rate, or a per-service rate, and it should reflect actual facility charges so the resident can make an informed decision.⁶

The Three Option Boxes

After the body, the beneficiary must check one of three options. The facility cannot make this choice. If the beneficiary is physically unable to mark a box, staff may enter the selection at the beneficiary’s request and note on the form that this was done.²

Option 1 keeps the care going and asks the facility to submit a claim to Medicare for a formal coverage decision. If Medicare denies it, the resident owes the bill but has the right to appeal, with instructions arriving on a Medicare Summary Notice. This is sometimes called a demand bill, and it is the choice that preserves appeal rights for a resident who believes the care is still medically necessary.

Option 2 keeps the care going but skips the Medicare claim. The resident pays out of pocket. Because no claim is filed, there is no denial to appeal.

Option 3 stops the listed care. No payment obligation arises and no appeal is available. Medicare Part B may still cover some services (not room and board), with applicable cost-sharing.⁵

Delivering the Notice

The SNF ABN must reach the beneficiary or their legal representative before the non-covered care begins.² Delivering it as early as practical gives the resident time to review the options, talk with family, or consult an advisor. Once the beneficiary selects an option, signs, and dates the notice, the facility must hand over a copy of the signed document. That copy is the resident’s record for any future appeal.

If the Resident Refuses to Sign

When a beneficiary or representative refuses to choose an option or sign, the facility should note the refusal directly on the original SNF ABN. Listing a witness is permitted but not required.⁷ A refusal to sign does not automatically mean the facility should keep providing the service at its own expense, but stopping care that would jeopardize the resident’s health and safety carries its own risks.

What Happens If the Notice Is Invalid

Section 1879 of the Social Security Act protects beneficiaries from financial liability when they were not properly told Medicare would likely deny payment.¹ A defective or missing SNF ABN generally prevents the facility from collecting anything from the resident for the affected services. CMS treats a defective notice as evidence that the facility knew Medicare would not pay, which blocks cost-shifting to the beneficiary.⁸ Any money the facility already collected in error must be refunded promptly.

Errors that commonly invalidate the form:

Using an outdated version of CMS-10055.
Leaving the reason for non-coverage blank or writing it too vaguely.
Omitting the cost estimate.
Delivering the notice after the non-covered care has already begun.
Pre-selecting an option box for the beneficiary.

What the Resident Can Do Next

Getting the SNF ABN does not mean Medicare coverage has already ended. It means the facility expects it to end. A resident who disagrees has the strongest path by picking Option 1, which forces a Medicare claim and a formal decision. If the claim is denied, the Medicare Summary Notice explains how to appeal.⁵ For free help thinking through the choice, contact your State Health Insurance Assistance Program (SHIP). And if the facility is actually ending all Medicare-covered services rather than shifting from skilled to custodial care, ask whether you should be receiving a NOMNC, which carries expedited review rights through a BFCC-QIO.⁴

1
Social Security Administration. Social Security Act 1879 – Limitation on Liability of Beneficiary Where Medicare Claims Are Disallowed
2
Centers for Medicare & Medicaid Services. SNF ABN Instructions
3
Medicare. Your Protections
4
Centers for Medicare & Medicaid Services. FFS and MA NOMNC/DENC
5
Centers for Medicare & Medicaid Services. Skilled Nursing Care Advance Beneficiary Notice
6
Centers for Medicare & Medicaid Services. SNF ABN Instructions
7
Centers for Medicare & Medicaid Services. MLN909183 – Advance Beneficiary Notice of Non-coverage Tutorial
8
Health Care Financing Administration. HCFA Ruling 95-1 – Requirements for Determining Limitation on Liability