Georgia Medicare ABN Advance Beneficiary Notice 2026

The Advance Beneficiary Notice of Noncoverage (ABN) is the foundational beneficiary protection notice in Medicare fee-for-service. It is the legal mechanism by which a Medicare provider or supplier transfers financial liability to a Medicare beneficiary for a service Medicare is likely to deny as "not reasonable and necessary" under Section 1862(a)(1)(A) of the Social Security Act or certain other specified statutory exclusions. Without a properly issued ABN, the provider (not the beneficiary) bears the financial liability when Medicare denies the claim.

The ABN framework was established by Section 4541 of the Balanced Budget Act of 1997 (BBA, Public Law 105-33), which added Section 1879 to the Social Security Act creating the "limitation on liability" structure. The implementing regulations are at 42 CFR 411.404 (limitation on liability) and 42 CFR 411.408 (refunds to beneficiaries). The current standardized notice is Form CMS-R-131, with parallel notices for specific settings: Form CMS-10055 (SNF-ABN) for skilled nursing facilities under certain conditions, Form CMS-10123 (Notice of Medicare Non-Coverage, NOMNC) for SNF/HHA/CORF/hospice termination, Form CMS-10066 (DND), Form CMS-10611 (MOON), and the Hospital-Issued Notice of Noncoverage (HINN) for inpatient hospital discontinuation.

The ABN's central logic is straightforward: when a Medicare provider believes Medicare will likely deny a specific service, the provider must give the beneficiary advance written notice describing the service, the specific reason Medicare is likely to deny it, the estimated cost, and three options the beneficiary can choose from. The beneficiary signs the form, selecting their option. With a properly issued ABN, the beneficiary becomes financially liable if Medicare denies the claim. Without a properly issued ABN, or with a defectively issued one, the provider absorbs the loss.

This guide explains how the ABN framework works under Medicare, when a provider must issue an ABN versus when issuance is voluntary, the three options the beneficiary can choose, the specific reason and estimated cost requirements, the record retention standard, the modifier GA/GZ/GX billing system, the coordination with NOMNC and HINN, the most common Georgia scenarios where ABNs appear, and the beneficiary protections that flow from a defectively issued ABN.

By Brevy Care Team

Legal foundation: Section 1879 and the limitation on liability

Section 1879 of the Social Security Act ("Limitation on liability of beneficiary where Medicare claims are disallowed") was added by Section 4541 of the Balanced Budget Act of 1997 (Public Law 105-33). The statute creates a structural beneficiary protection: when a Medicare claim is denied as not reasonable and necessary, or as custodial care, or for certain other reasons, the beneficiary is generally not financially liable if the beneficiary "did not know, and could not reasonably have been expected to know, that payment would not be made" for the service.

The ABN is the operational mechanism that converts the "did not know" presumption into informed knowledge. By issuing a properly executed ABN before furnishing the service, the provider gives the beneficiary written notice of the specific reason Medicare is likely to deny and the estimated cost, extinguishing the "did not know" defense.

The implementing regulations at 42 CFR 411.404 spell out the substantive limitation on liability. The regulations at 42 CFR 411.408 govern the refunds-to-beneficiaries process when the ABN is not properly issued and Medicare denies the claim; the provider may be required to refund any amount collected from the beneficiary and may absorb the loss.

The ABN form (CMS-R-131): structure and required content

Form CMS-R-131 is the standardized ABN notice. CMS publishes the form template; providers cannot use alternative forms for the mandatory ABN context. The form has structured fields, all of which must be completed for the ABN to be valid:

Required content fields

1. Notifier information: name and contact information of the provider issuing the ABN
2. Patient name and ID: beneficiary identification
3. Service description: clear description of the specific service Medicare is likely to deny (not a generic category)
4. Reason Medicare may not pay: specific reason explaining the likely denial (not boilerplate)
5. Estimated cost: good-faith estimate of what the beneficiary will be charged
6. Three beneficiary options: the beneficiary selects one
7. Beneficiary signature and date: acknowledgment

The three options

The beneficiary must choose exactly one of three options:

Option 1: I want the [service] listed above. You may ask to be paid now, but I also want Medicare billed for an official decision on payment, which is sent to me on a Medicare Summary Notice (MSN). I understand that if Medicare doesn't pay, I am responsible for payment, but I can appeal to Medicare by following the directions on the MSN.

This is the most common selection. The beneficiary receives the service, the provider bills Medicare, and the beneficiary is responsible if Medicare denies. The denial generates an MSN with appeal rights.

Option 2: I want the [service] listed above, but do not bill Medicare. You may ask to be paid now as I am responsible for payment. I cannot appeal if Medicare is not billed.

The beneficiary receives the service, the provider does not bill Medicare, and the beneficiary pays directly. No appeal rights because no Medicare decision.

Option 3: I don't want the [service] listed above. I understand with this choice I am not responsible for payment, and I cannot appeal to see if Medicare would pay.

The beneficiary declines the service. No payment, no appeal rights, no service furnished.

Why the option matters

The option choice has appeal-rights and financial consequences. Option 1 preserves appeal rights: if Medicare denies, the beneficiary can appeal through the standard appeals process (redetermination, reconsideration, ALJ hearing, Medicare Appeals Council, federal court). Option 2 forecloses appeal rights because no Medicare decision is made. Option 3 forecloses appeal rights because no service is furnished.

For most beneficiaries facing an ABN, Option 1 is the right choice. It costs nothing extra (other than the contingent liability if Medicare denies), preserves appeal rights, and produces an MSN documenting the denial.

Mandatory ABN issuance conditions

A provider must issue an ABN when both:

1. The service is a Medicare benefit (or could be one), AND
2. The provider believes Medicare will likely deny the service as:
   • Not reasonable and necessary under Section 1862(a)(1)(A), OR
   • Custodial care under Section 1862(a)(9), OR
   • Subject to certain other specified exclusions (frequency limits, hospice non-related conditions, etc.)

Common mandatory ABN triggers in Georgia

• Skilled therapy without meaningful improvement: outpatient PT, OT, SLP continuing past the point where Medicare's improvement standard or maintenance threshold supports continued coverage
• Routine foot care without qualifying systemic disease: podiatry beyond the limited routine foot care exceptions
• Hospital observation continued past medical necessity
• DMEPOS items beyond frequency/utility limits: for example, mobility equipment when prior equipment remains functional
• Certain laboratory tests not meeting medical necessity: for example, screening lab tests above frequency limits
• Certain imaging studies beyond medical necessity standards
• Certain surgical procedures flagged for medical necessity review
• Inpatient hospital discharge readiness (HINN territory rather than ABN, but conceptually parallel)

Custodial care

"Custodial care" under Section 1862(a)(9) is care that does not require skilled nursing or skilled rehabilitation services and consists of activities of daily living assistance. Medicare does not cover custodial care. When a SNF, HHA, or other provider knows a beneficiary's care has become custodial, ABN (or SNF-ABN, depending on context) issuance is required.

Voluntary ABN issuance

An ABN may be issued voluntarily for services that are categorically not Medicare benefits, that is, services Medicare never covers because they are statutorily excluded. Voluntary ABN issuance is a beneficiary courtesy: it documents that the provider informed the beneficiary the service is not Medicare-covered and the beneficiary will pay.

Common voluntary ABN scenarios

• Cosmetic procedures: Medicare does not cover cosmetic surgery
• Routine eye examinations and refraction: Medicare does not cover routine vision refraction
• Hearing aids and routine hearing examinations: Medicare does not cover hearing aids
• Routine dental services: Medicare does not cover most routine dental work
• Self-administered drugs in outpatient settings: Medicare Part B does not cover self-administered drugs
• Services outside the United States: Medicare does not cover services outside the US (with limited exceptions)

For voluntary ABNs, the form is issued for documentation; provider liability under Section 1879 does not attach because Medicare was never going to cover the service. The beneficiary's financial responsibility was always present.

Modifier GX for voluntary ABNs

When a voluntary ABN is issued and the service is billed to Medicare (for example, when the beneficiary requests it), the modifier GX signals "Notice of liability issued, voluntary under payer policy."

Modifier GA, GZ, GX billing system

The three relevant ABN-related modifiers signal different ABN circumstances to Medicare:

Modifier GA: ABN on file (mandatory)

• Used when ABN was required and issued
• Signals expected denial as not reasonable and necessary
• Beneficiary liability transferred via ABN

Modifier GZ: Expected denial without ABN

• Used when ABN was required but NOT issued
• Signals expected denial as not reasonable and necessary
• Beneficiary liability NOT transferred; provider absorbs the loss

Modifier GX: Voluntary ABN issued

• Used when ABN was voluntary (statutorily excluded service)
• Signals beneficiary notified of non-coverage as courtesy
• Beneficiary always liable; Section 1879 not engaged

Why GZ exists

Modifier GZ allows the provider to acknowledge to Medicare that ABN was required but not issued. The provider effectively flags the claim for likely denial and acknowledges responsibility for non-payment. CMS uses GZ data to track ABN compliance.

ABN timing: must be issued before service

The ABN must be issued BEFORE the service is furnished. Post-service ABN issuance is invalid. Section 1879's protection is forward-looking, and the beneficiary cannot make an informed choice about a service that has already been furnished.

Practical timing: issue the ABN at the encounter when the service is scheduled or about to be furnished, with enough time for the beneficiary to read, ask questions, and select an option. CMS guidance discourages "drive-by" ABN issuance just as the patient is about to be brought into a procedure room.

For ongoing services where the likely denial reason emerges over time (e.g., outpatient therapy continuing past meaningful improvement), the ABN must be issued when the provider's belief about likely denial crystallizes, not retrospectively after sessions have already been furnished.

Specific reason for likely denial

The ABN's "Reason Medicare may not pay" field requires specificity. Generic statements like "Medicare may not cover this service" do not satisfy the requirement. The reason must explain why Medicare is likely to deny THIS specific service for THIS specific beneficiary.

Examples of acceptable specific reasons:

• "Continued outpatient PT after plateau in functional improvement; Medicare requires meaningful improvement or maintenance therapy threshold."
• "Routine foot care without systemic disease diagnosis qualifying for routine foot care exception (e.g., diabetic neuropathy)."
• "Custodial-level care; skilled need has resolved."
• "Frequency limit exceeded; this is the second annual mammography screening within 12 months."

A specific reason supports beneficiary understanding and supports the validity of the ABN if reviewed.

Estimated cost disclosure

The ABN requires a good-faith estimated cost the beneficiary will be charged if Medicare denies the claim. The estimate need not be exact, but it must be reasonable based on the provider's typical charges. Failure to include an estimate, or providing a grossly inaccurate estimate, can invalidate the ABN.

For Georgia practices, the estimate generally reflects the practice's standard charge for the service. The beneficiary's actual out-of-pocket may differ if a supplemental insurance covers some portion, but the ABN reflects the gross charge.

ABN record retention

Providers must retain executed ABN forms per CMS retention requirements. The retention requirement supports CMS audit, beneficiary dispute resolution, and legal defense if the ABN's validity is challenged.

Coordination with parallel notices

The ABN is one of several Medicare beneficiary notices. Adjacent notices for specific settings:

Notice of Medicare Non-Coverage (NOMNC, Form CMS-10123)

• Used when a Medicare-covered service is ending (SNF stay, home health episode, CORF services, hospice election)
• Issued in advance before service ends
• Triggers an expedited QIO appeal opportunity
• Different framework from ABN: NOMNC announces termination of covered service; ABN announces likely denial of about-to-be-furnished service

Hospital-Issued Notice of Noncoverage (HINN)

• Used when an inpatient hospital stay is determined to no longer require inpatient level
• Triggers QIO review opportunity
• Different from ABN; specific to inpatient hospital discontinuation

SNF-ABN (Form CMS-10055)

• Used in SNF context when skilled care is ending or skilled-level criteria no longer met
• SNF-specific form

Detailed Notice of Discharge (DND, Form CMS-10066)

• Hospital-specific discharge notice when QIO review is requested

Medicare Outpatient Observation Notice (MOON, Form CMS-10611)

• Used when a beneficiary has been receiving extended outpatient observation services
• Different from ABN; informs beneficiary of observation status and financial implications

BFCC-QIO for Georgia

Georgia beneficiaries who receive a NOMNC, HINN, or DND and disagree can request expedited QIO review through Acentra Health, the Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO) serving Georgia.

Beneficiary protections when ABN is defectively issued

A defectively issued ABN does not transfer liability. Defects include:

• Pre-service requirement not met (issued after service)
• Specific reason not provided (generic boilerplate)
• Estimated cost not provided
• Beneficiary signature missing
• ABN issued under duress or without genuine choice
• Form CMS-R-131 not used in mandatory ABN contexts
• Coercive language pressuring a specific option

When an ABN is defective, the beneficiary is not liable, and the provider absorbs the financial loss if Medicare denies. The beneficiary may dispute charges based on defective ABN and may obtain refunds for amounts already paid under 42 CFR 411.408.

For Georgia beneficiaries who suspect a defective ABN, GeorgiaCares SHIP, Atlanta Legal Aid, and the Medicare Beneficiary Ombudsman provide assistance.

Worked examples

1. Fulton 70: outpatient PT continuation past plateau

A 70-year-old Fulton County beneficiary has been receiving outpatient physical therapy at an Emory clinic following total knee arthroplasty. Three months in, the therapist documents that the beneficiary has reached a functional plateau; further skilled therapy is unlikely to produce meaningful improvement. The clinic believes Medicare will likely deny continued PT sessions as not reasonable and necessary.

Before the next session, the clinic issues a mandatory ABN (Form CMS-R-131) describing the continued PT service, the specific reason (functional plateau; Medicare requires meaningful improvement or maintenance therapy threshold), the estimated cost ($150/session), and the three options. The beneficiary selects Option 1 (receive service, bill Medicare). Future sessions are billed with modifier GA.

If Medicare denies, the beneficiary is responsible for the charges but retains appeal rights via MSN.

2. DeKalb 75: routine foot care podiatry

A 75-year-old DeKalb County beneficiary visits a podiatrist for routine toenail trimming. The beneficiary does not have diabetes, peripheral vascular disease, or other systemic disease qualifying for the routine foot care exception. The podiatrist believes Medicare will likely deny the service as routine foot care.

Before the service, the podiatrist issues an ABN describing the routine toenail trimming, the specific reason (no qualifying systemic disease diagnosis), the estimated cost ($45), and the three options. The beneficiary selects Option 1. The claim is billed with modifier GA.

Medicare denies the claim. The beneficiary receives an MSN showing the denial and is responsible for the $45 charge.

3. Cobb 68: cosmetic procedure

A 68-year-old Cobb County beneficiary seeks a cosmetic blepharoplasty (eyelid lift) without any documented medically necessary indication. Cosmetic procedures are statutorily excluded from Medicare coverage.

The surgeon issues a voluntary ABN as a courtesy, explaining that Medicare does not cover cosmetic procedures, the estimated cost ($4,000), and confirming the beneficiary's understanding. Beneficiary signs and pays directly. If the surgeon bills Medicare (with the beneficiary's request), the claim is submitted with modifier GX.

The beneficiary is fully responsible for the cost; Medicare denial generates no appeal rights because cosmetic procedures are statutorily excluded.

4. Worth County 72: hearing aid evaluation

A 72-year-old Worth County beneficiary visits an audiologist for hearing aid evaluation. Medicare does not cover routine hearing examinations or hearing aids (with limited exceptions).

The audiologist issues a voluntary ABN as a courtesy, explaining the non-coverage, estimated cost ($300 for evaluation; hearing aid cost separate), and the three options. The beneficiary acknowledges and proceeds. Service billed (if billed) with modifier GX.

5. Bibb 80: SNF stay transition to custodial level

An 80-year-old Bibb County beneficiary is in day 25 of a SNF stay following hospital discharge. The skilled care need has resolved; remaining care is custodial. The SNF must issue a SNF-ABN (Form CMS-10055) informing the beneficiary that Medicare coverage is ending because skilled-level criteria no longer apply.

The SNF-ABN is issued, beneficiary signs, and Medicare coverage ends per the form. Beneficiary may continue at custodial level under private pay, Medicaid (if eligible), or other coverage.

6. Hall 67: vision refraction voluntary ABN

A 67-year-old Hall County beneficiary visits an optometrist for an eye examination including refraction for new eyeglasses. Medicare does not cover routine refraction.

The optometrist issues a voluntary ABN explaining refraction is not Medicare-covered, estimated cost ($60), and the three options. Beneficiary acknowledges and pays directly. Service billed (if billed for accommodation purposes) with modifier GX.

14 best practices for Georgia ABN handling

1. Issue mandatory ABNs only when the provider genuinely believes Medicare will likely deny. Routine "just in case" ABN issuance dilutes the form's protective function and invites CMS scrutiny.

2. Provide a specific reason for likely denial. Generic boilerplate invalidates the ABN. Tailor each ABN's reason field to the specific clinical and coverage context.

3. Include a good-faith estimated cost. Use the practice's standard charge as the basis.

4. Issue the ABN before the service is furnished. Post-service ABN is invalid.

5. Allow the beneficiary genuine choice. Coercive ABN issuance — pressuring a specific option — can invalidate the form.

6. Document the beneficiary's signed selection. Filing the ABN in the medical record supports retention compliance.

7. Use Form CMS-R-131 for mandatory ABNs. Alternative forms are not accepted.

8. Use the SNF-ABN (CMS-10055) in SNF contexts. SNF-specific notice differs from general ABN.

9. Use NOMNC for service termination, HINN for inpatient discontinuation. Different notices for different situations.

10. Apply modifier GA to claims with mandatory ABN on file. Modifier GZ when ABN should have been issued but wasn't. Modifier GX for voluntary ABNs.

11. Retain executed ABN forms per CMS retention requirements. Audit and beneficiary dispute defense.

12. Train clinical and front-office staff on ABN triggers. Skilled therapy plateau, custodial transition, frequency limits, statutory exclusions.

13. Provide ABN-related beneficiary education. Explain the three options and appeal rights orally; the form provides written notice but does not substitute for plain-language explanation.

14. Audit ABN compliance periodically. Random sample review of ABN issuance, completeness, and modifier use supports continued compliance.

14 common issues and how to handle them

1. ABN issued after service. Invalid; beneficiary not liable for the denied service; provider absorbs loss.

2. Generic boilerplate in reason field. May invalidate; tailor each reason specifically.

3. Missing estimated cost. May invalidate; provide good-faith estimate.

4. Form CMS-R-131 not used for mandatory ABN. Alternative forms may not be accepted; use the standard form.

5. Beneficiary signature missing. Without signature, ABN not executed.

6. ABN issued under duress. Coercion can invalidate; respect beneficiary's right to genuine choice.

7. Multiple services on one ABN with one generic reason. Each distinct service should have its own ABN or be separately addressed.

8. Provider claims ABN on file but cannot produce it. Retention required; failure to produce undermines the ABN's protective effect.

9. Modifier GA applied without an actual ABN. Fraudulent modifier use creates audit and overpayment risk.

10. Voluntary ABN treated as mandatory ABN. Different framework; statutory exclusions never required ABN; voluntary ABN is courtesy.

11. NOMNC issued for ABN situation or vice versa. Different notices for different situations; mismatching them creates beneficiary confusion and appeal-rights confusion.

12. Beneficiary's chosen option not honored. Provider must honor the option selected: receive and bill, receive without billing, or decline.

13. Provider attempts to collect from beneficiary without proper ABN. Beneficiary may dispute and pursue refund under 42 CFR 411.408.

14. Recurring ABN for the same ongoing situation without re-evaluation. ABNs should reflect current clinical and coverage context; periodic re-evaluation supports validity.

Common Georgia ABN scenarios

Skilled therapy continuation

Outpatient PT, OT, SLP at Georgia health systems and outpatient therapy networks (BenchMark, Drayer, Athletico, hospital-based). ABN issued when functional plateau or maintenance-only therapy threshold reached.

Routine foot care

Podiatry visits across Georgia. ABN required when no qualifying systemic disease diagnosis supports the routine foot care exception.

Routine vision and hearing

Optometry and audiology visits. Voluntary ABN for refraction-only services and hearing aid evaluations.

DMEPOS frequency limits

Mobility equipment, CPAP/BiPAP supply, glucose testing supplies. ABN when frequency limits exceeded.

Custodial care transitions

SNF stays transitioning from skilled to custodial level. SNF-ABN required.

Home health discharge

Home health episodes ending. NOMNC issued.

Hospital observation extending past threshold

MOON notice required (CMS-10611). Distinct from ABN but adjacent in beneficiary notice framework.

Inpatient hospital discharge readiness

HINN issued when inpatient level no longer appropriate.

Cosmetic procedures

Statutorily excluded; voluntary ABN courtesy.

Self-administered drugs in outpatient settings

Statutorily not Part B-covered; voluntary ABN courtesy.

Georgia ABN compliance landscape

Major Georgia provider compliance focus areas

• Hospital systems: Emory, Wellstar, Piedmont, Northside, Augusta University, Atrium Health Navicent, Memorial Health, Phoebe Putney, Northeast Georgia — all maintain ABN policies and compliance training
• Outpatient therapy networks: BenchMark, Drayer, Athletico
• Podiatry practices: independent and health-system-affiliated
• Optometry and audiology practices
• DMEPOS suppliers: Palmetto GBA-credentialed
• SNF and home health agencies: using SNF-ABN, NOMNC

Acentra Health (Georgia BFCC-QIO)

Acentra Health is Georgia's Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO). It reviews NOMNC, HINN, and DND appeals for Georgia Medicare beneficiaries. Acentra is not the ABN review entity (ABN-related denials proceed through MAC appeals), but its role in adjacent termination notices intersects with the ABN framework.

Palmetto GBA (Georgia MAC)

Palmetto GBA processes Medicare fee-for-service claims for Georgia. ABN-related denials, modifier GA/GZ/GX claims, and beneficiary appeals flow through Palmetto.

GeorgiaCares SHIP

GeorgiaCares provides free Medicare counseling including ABN interpretation, options counseling, and appeals assistance for Georgia beneficiaries.

Why ABN coverage matters for every Georgia Medicare beneficiary facing potentially non-covered services

The ABN is one of the most important and most misunderstood Medicare beneficiary protections. For Georgia beneficiaries who receive an ABN at a podiatry visit, an outpatient therapy session, a SNF transition, or a DMEPOS evaluation, the form represents a structural moment in their Medicare relationship: a provider believes Medicare will likely deny a specific service, written notice is given, and the beneficiary decides whether to proceed with informed liability or to decline.

Without ABNs, two bad outcomes would flow. First, providers would absorb all financial losses from Medicare denials of services that beneficiaries didn't realize would be denied, and would either avoid those services or pass the costs through indirect means. Second, beneficiaries would discover post-service that Medicare didn't cover something they expected covered and would face surprise bills with no advance notice. The ABN structure solves both problems by requiring advance written notice with specific reasons, estimated costs, and a beneficiary choice.

For the 70-year-old Fulton County beneficiary whose outpatient PT has reached a plateau, the ABN is the moment of informed decision: continue knowing the cost, continue without billing Medicare, or stop. For the 75-year-old DeKalb County beneficiary getting routine toenail trimming, the ABN explains why Medicare doesn't cover routine foot care without qualifying systemic disease, and lets the beneficiary decide if a $45 podiatry charge is worth paying. For the 80-year-old Bibb County beneficiary whose SNF stay is transitioning from skilled to custodial, the SNF-ABN marks the formal end of Medicare coverage and the beginning of alternative coverage planning.

Every Georgia Medicare beneficiary will likely encounter an ABN at some point during their Medicare years. Understanding the form: what it means, what the three options are, what the financial and appeal-rights consequences are, and what defective issuance looks like, converts the ABN from a confusing paperwork moment into a meaningful exercise of informed beneficiary choice.

Resources and contacts

• Medicare: 1-800-MEDICARE (1-800-633-4227)
• Palmetto GBA MAC: Contact via Medicare.gov or the Medicare provider line
• DCH Medicaid Member Services: Contact via Georgia DCH
• GeorgiaCares SHIP: georgiacares.org
• Medicare Rights Center: medicarerights.org
• Center for Medicare Advocacy: medicareadvocacy.org
• Acentra Health QIO (Georgia BFCC-QIO): Contact via Medicare.gov
• Medicare Beneficiary Ombudsman: medicare.gov/claims-appeals/your-medicare-rights
• Atlanta Legal Aid: atlantalegalaid.org
• Georgia Legal Services: glsp.org
• 211 Georgia
• Eldercare Locator: eldercare.acl.gov
• Georgia DPH: dph.georgia.gov
• Social Security Administration: ssa.gov
• Georgia Council on Aging
• AARP Georgia

Find personalized help navigating Medicare ABN questions at brevy.com.

This guide reflects Medicare ABN framework as of 2026-05-14. ABN coverage is governed by Section 1879 of the Social Security Act (added by BBA 1997 Section 4541, Public Law 105-33), 42 CFR 411.404, 42 CFR 411.408, and current CMS form and policy guidance. For the most current guidance, consult Medicare.gov, your MAC (Palmetto GBA in Georgia), and your Georgia health provider.