Reason Code 176 | Remark Code N115

Code Description
Reason Code: 176 Prescription is not current.
Remark Code: N115 This decision was based on a Local Coverage Determination (LCD)

Common Reasons for Denial

  • A recent break in medical need
  • 13/15 months have been paid
  • Same and Similar equipment on file

Next Step

  • Submit an Redeterminations/Appeals with all documentation to support medical need and indicate on appeal/redetermination explanation that there was a break medical need

How to Avoid Future Denials

  • If a break in medical need, submit initial claim with a narrative BIN (break in need)
  • The Noridian Medicare Portal can be accessed under Same or Similar to verify number of rental payments or similar equipment on file or call the Noridian Interactive Voice Response (IVR) System for that information
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