Reason Code 5J504

Reason Code Narrative

NEED FOR SERVICE/ITEM NOT MEDICALLY AND REASONABLY NECESSARY.

Common Reason Code Errors

  • Claim information received does not support medical need/level of service provided

Common Reason Code Corrections

  • A Redetermination request may be submitted if facility feels that sending additional documentation will support need for service(s) provided. Request should include:
    • All applicable supporting medical documentation
    • Corrected UB-04 form

Resource

View reason code list, return to Reason Code Guidance page.

 

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