• Advanced Beneficiary Notice of Coverage (ABN)

    NOTE: If Medicare doesn't pay for D. Routine Foot Care below, you may have to pay. Medicare does not pay for everything, even some care that you or your health care provider have good reason to think you need. We expect Medicare may not pay for the D. Routine Foot Care below.
  •  

    D. Rountine Foot Care E. Reason Medicare May Not Pay  F. Estimated Cost 

    Thick Nails

    11721

    11720

    Normal Nails 

    11719

    Calluses 

    11055

    11056

    11057

     

    Patient has not met DEDUCTIBLE

    Minimum Deductile is $200 for 2020

    11721- $47.21

    11720- $34.14

    11719-$14.93

    11055-$57.32

    11056- $68.68

    11057-$76.48

  • WHAT YOU NEED TO DO NOW:
    • Read this notice, so you can make an informed decision about your care.
    • Ask us any questions that you may have after you finish reading.
    • Choose an option below about whether to receive the D.  listed above.
    Note: If you choose Option 1 or 2, we may help you to use any other insurance
    that you might have, but Medicare cannot require us to do this.

  • Options:

  • H. Additional Information:

     

  • This notice gives our opinion, not an official Medicare decision. If you have other questions on this notice or Medicare billing, call 1-800-MEDICARE (1-800-633-4227/TTY: 1-877-486-2048).
    Signing below means that ou have received and understand this notice. You also receive a copy.

  • Clear
  •  -  -
    Pick a Date
  • Should be Empty: