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Denial Code Guidance

View the most common claim submission errors with a description, solutions, and ways to prevent these in the future.

The Washington Publishing Company This link will take you to an external website. publishes the CMS-approved Reason Codes This link will take you to an external website. and Remark Codes This link will take you to an external website..

  • Remittance Advice Remark Codes (RARCs) are used to provide additional explanation for an adjustment already described by a CARC or to convey information about remittance processing.
  • Claim Adjustment Reason Codes (CARCs) communicate an adjustment, meaning that they must communicate why a claim or service line was paid differently than it was billed. If there is no adjustment to a claim/line, then there is no adjustment reason code.
Remark Code/Reason Code Brief Description
M2 / 97 The beneficiary was inpatient on the date of service billed.
M3 M25 / 151 The item billed is same or similar to an item already received in the beneficiary's history.
M114 N565 / 4
  • The HCPCS code is inconsistent with the modifier used or a required modifier is missing.
  • The item billed was processed under the DMEPOS Competitive Bidding Program and requires an appropriate competitive bid modifier.
M124 / 16 The item billed does not have the base equipment on file. The main equipment is missing therefore Medicare will not pay for supplies.
MA13 N264 N575 / 16 The item(s) billed did not have a valid ordering physician name.
MA13 N265 N276 / 16 The item(s) billed did not have a valid ordering physician National Provider Identifier (NPI) registered in Medicare Provider Enrollment, Chain and Ownership System (PECOS).
N102 / 50 The documentation requested was not received or was not received timely.
N104 / 109 The claim was submitted to the incorrect Jurisdiction.
N115 / 50
  • The item billed may require a specific diagnosis or modifier code based on the related LCD.
  • A development letter requesting additional documentation to support the service billed was not received within the provided timeline.
  • The item being billed does not meet medical necessity.
N115 / 151 There is a date span overlap or overutilization based on the related LCD.
N130 / 109 The claim was submitted to the incorrect contractor.
N130 / 204
  • This is a noncovered item.
  • The item is not medically necessary for DME.
N159 / 4 The HCPCS code is inconsistent with the modifier used or required modifier is missing.
N370 / A1 The oxygen equipment has exceeded the number of approved paid rentals.
N390 / 97 The HCPCS code billed is included in the payment/allowance for another service/procedure that has already been adjudicated
N418 / 109
  • Claim was billed to the incorrect contractor.
  • The beneficiary was enrolled in a Medicare Health Maintenance Organization (HMO) for the date of service submitted.
N592 / 176 The item billed requires a recertified or revised Certificate of Medical Necessity (CMN) or DME Information Form (DIF) to be submitted. Either a CMN/DIF was not submitted or not on file with Noridian.
N668 / 173
  • The item billed requires an initial Certificate of Medical Necessity (CMN) or DME Information Form (DIF) be submitted.
  • An initial CMN or DIF was not submitted with the claim or on file with Noridian.

 

Last Updated Jun 08, 2016