Reason Code 204 | Remark Code N130 - JA DME
Reason Code 204 | Remark Code N130
| Code | Description |
|---|---|
| Reason Code: 204 | This service/equipment/drug is not covered under the patient's current benefit plan. |
| Remark Code: N130 | Consult plan benefit documents/guidelines for information about restrictions for this service. |
Common Reasons for Denial
- This is a noncovered item
- Item is not medically necessary
Next Step
- A Redetermination request may be submitted with all relevant supporting documentation. Noridian encourages Redeterminations/Appeals be submitted using the Noridian Medicare Portal. Review applicable Local Coverage Determination (LCD), LCD Policy Article, and Documentation Checklists prior to submitting request.
How to Avoid Future Denials
- In order for an item to be covered by DME MAC, it must fall within one of ten benefit categories. Some items may not meet definition of a Medicare benefit or may be statutorily excluded
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