Reason Code 16 | Remark Code M124 - JA DME

Common Reasons for Denial

• Item billed does not have base equipment on file. Main equipment is missing therefore Medicare will not pay for accessories or supplies. Suppliers must ensure that the beneficiary-owned equipment information is on file with Medicare Fee- for-Service (FFS) to avoid denials.
• This normally occurs when base item is provided prior to becoming Medicare eligible.
• Examples of items beneficiary owned are Positive Airway Pressure (PAP) devices, BiPAPs, nebulizers, all glucose monitors, and humidifiers, etc.

Next Step to Resolve

• Beneficiary owned information must be on file with Medicare for base item in order to qualify for accessories or supplies.
• Information required:
• Beneficiary owned item HCPCS; approximate purchased month and year
• Good example: Bene-owned E0601 pur Jan 2023 (approximate)

Methods to Place Information on File for Claims Processing

• If a denial is received with Reason Code 16, Remark Code M124
• Contact the Supplier Contact Center to request a telephone reopening
  • Request beneficiary owned equipment information be placed on file for base item for the accessories or supplies being billed
  • If telephone reopening is unavailable, supplier contact center will provide guidance on next step to resolve
  • Submit appeal/redetermination through the NMP appeals process when required (supplier contact center will provide that guidance)
• Review claim, was narrative entered for beneficiary owned base item?
• If answer is no, and claim denied as unprocessable, add required beneficiary information to claim and resubmit as new claim. This does not add beneficiary owned equipment information to history for beneficiary on subsequent claims and will need to be added through telephone reopenings
• Written reopening
• NMP appeals process
• Mail
• Fax
• Add required information to the narrative of every claim line for supplies used with base item not on file with Medicare until item has been placed on file
  • Item 19 of the 1500 claim form or the 2400/NTE segment of an electronic claim. Claims lacking any one of the elements above will be denied for missing information.

Once the beneficiary-owned item is placed on file, subsequent supply claims do not require a narrative.

How to Avoid Future Denials

• Suppliers must ensure that the beneficiary-owned equipment information is on file with Medicare Fee- for-Service (FFS) to avoid denials.
  • Suppliers can check Same or Similar on the Noridian Medicare Portal or through the Noridian Interactive Voice Response (IVR) System to ensure that beneficiary owned equipment is on file prior to submitting claims for accessories or supplies.