Reason Code 96 | Remark Code N425 - JA DME

Common Reasons for Denial

• Non-covered charge(s). Medicare does not pay for this service/equipment/drug.

Next Step

• If billed incorrectly (such as inadvertently omitting a required modifier), request a reopening. Utilize the Noridian Modifier Lookup Tool to ensure proper modifiers are included on claim
• If required diagnosis is not appended, reopen claim on the Noridian Medicare Portal (NMP) and append correct diagnosis code.
• If is for the KX, GA, GZ, or GY modifiers, 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

• Review applicable Local Coverage Determination (LCD), LCD Policy Article documentation requirements for coverage and use of modifiers. Utilize the Noridian Modifier Lookup Tool to ensure proper modifiers are included on claim, prior to billing. Ensure a required diagnosis is included on the claim line.