The more I think about it, I realize that because Medicare would never pay for a sports physical in the first place, it wouldn't need an ABN. Therefore, Medicaid has nothing to do with it, if I am not mistaken, because no claim is being submitted. This is strictly a self-pay service, and should be billed as such. While I understand that the patients in this situation are developmentally disabled, if Medicare is their primary insurance, you follow Medicare's rules about whether or not an ABN needs to be issued, or not, and if not, then you handle it like any other service that is never covered by an insurance company.