Denial Code Resolution

View the most common claim submission errors below. To access a denial description, select the applicable Reason/Remark code found on Noridian's Remittance Advice. Select the Reason or Remark code link below to review supplier solutions to the denial and/or how to avoid the same denial in the future.

The Washington Publishing Company publishes the CMS-approved Reason Codes and Remark Codes.

  • 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.
  • 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.
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Reason Code Remark Code Common Reasons for Denials
4 M114
N565
  • HCPCS code is inconsistent with modifier used or a required modifier is missing
  • Item billed was processed under DMEPOS Competitive Bidding Program and requires an appropriate competitive bid modifier
4 N519
  • HCPCS code is inconsistent with modifier used or required modifier is missing
5 M77
  • The procedure code/bill type is inconsistent with the place of service
  • Missing/incomplete/invalid place of service
13  
  • The date of death precedes the date of service.
16 M51
  • Claim/service lacks information or has submission/billing error(s)
  • Missing/incomplete/invalid procedure code(s)
16 M77
  • Claim/service lacks information or has submission/billing error(s)
  • Missing/incomplete/invalid place of service
16 M124
  • Item billed does not have base equipment on file. Main equipment is missing therefore Medicare will not pay for supplies
16 MA13
N264
N575
  • Item(s) billed did not have a valid ordering physician name
16 MA13
N265
N276
  • Item(s) billed did not have a valid ordering physician National Provider Identifier (NPI) registered in Medicare Provider Enrollment, Chain and Ownership System (PECOS)
16 MA27
N382
  • Claim/service lacks information or has submission/billing error(s)
  • Missing/incomplete/invalid Information
16 MA83
  • Claim/service lacks information or has submission/billing error(s).
  • Did not indicate whether we are the primary or secondary payer.
16 M76
  • Claim/service lacks information or has submission/billing error(s) which is needed for adjudication. Missing/incomplete/invalid diagnosis or condition.
16 N286
  • The referring provider identifier is missing, incomplete or invalid
18 N522
  • Duplicate claim has already been submitted and processed
22 MA04
  • This claim appears to be covered by a primary payer. The primary payerinformation was either not reported or was illegible
29 N211
  • The time limit for filing has expired.
  • You may not appeal this decision.
31  
  • Patient cannot be identified as our insured.
35 N370
  • Maximum rental months have been paid for item
45 N88
  • Payment was made for this claim conditionally because an HHA episode of care has been filed for this patient.
50  
  • Claim is missing a Certification of Medical Necessity or DME Information Form
  • Claim is missing the KX modifier
  • This is not a service covered by Medicare
  • Documentation requested was not received or was not received timely
  • Item billed may require a specific diagnosis or modifier code based on related LCD
  • Item being billed does not meet medical necessity
50 M127
  • These are non-covered services because this is not deemed a 'medical necessity' by the payer.
  • Missing patient medical record for this service.
50 N115
  • These are non-covered services because this is not deemed a 'medical necessity' by the payer.
  • This decision was based on a Local Coverage Determination (LCD). An LCD provides a guide to assist in determining whether a particular item or service is covered.
50 N130
  • Item billed does not meet medically necessity
  • Non Covered item
50 N180
  • These are non-covered services because this is not deemed a 'medical necessity' by the payer.
  • This item or service does not meet the criteria for the category under which it was billed.
96 M18
  • Beneficiary was inpatient on date of service billed
96 N115
  • Non-covered charge(s).
  • This decision was based on a Local Coverage Determination (LCD). An LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy is available on the Medicare Coverage Database, or if you do not have web access, you may contact the contractor to request a copy of the LCD.
96 N180
  • Non-covered charge(s). Item does not meet the criteria for the category under which it was billed.
96 N425
  • Non-covered charge(s). Medicare does not pay for this service/equipment/drug.
97 M2
  • Beneficiary was inpatient on date of service billed
97 M80
  • HCPCS billed is included in payment/allowance for another service/procedure that was already adjudicated
97 N390
  • HCPCS code billed is included in payment/allowance for another service/procedure that has already been adjudicated
107  
  • The related or qualifying claim/service was not identified on this claim.
108 N130
  • The equipment is billed as a purchased item when only covered if rented.
109 N104
  • Claim was submitted to incorrect Jurisdiction
  • Claim must be submitted to the Jurisdiction listed as the beneficiary’s permanent address with the Social Security Administration
109 N130
  • Claim was submitted to incorrect contractor
  • Was beneficiary inpatient on date of service?
109 N418
  • Claim was billed to incorrect contractor
  • For date of service submitted, beneficiary was enrolled in a Medicare Health Maintenance Organization (HMO)
109 N538
  • Beneficiary was inpatient on date of service billed
119 M86
  • Item has met maximum limit for this time period. Payment already made for same/similar procedure within set time frame.
150 N115
  • Policy frequency limits may have been reached, per LCD
151  
  • Equipment is the same or similar to equipment already being used.
  • There is a date span overlap or overutilization based on related LCD
151 M3
M25
  • Item billed is same or similar to an item already received in beneficiary's history
151 N115
  • There is a date span overlap or overutilization based on related LCD
173 N668
  • An initial Certificate of Medical Necessity (CMN) or DME Information Form (DIF) was not submitted with claim or on file with Noridian
175 N668
  • Prescription is not on file or is incomplete or invalid
176 N115
  • A recent break in medical need
  • 13/15 months have been paid
  • Same and Similar equipment on file
176 N592
  • • Recertified or revised Certificate of Medical Necessity (CMN) or DME Information Form (DIF) for item was not submitted or not on file with Noridian
182 N517
  • Invalid modifier for date of service
204 N130
  • Noncovered item
  • Item is not medically necessary for DME
234 N20
  • Item billed is included in allowance of other service provided on the same date
A1 N370
  • Oxygen equipment has exceeded number of approved paid rentals
B7 N570
  • This provider was not certified/eligible to be paid for this procedure/service on this date of service.
  • Missing/incomplete/invalid credentialing data.
B9  
  • Patient is enrolled in a hospice program.
B20  
  • Item was partially or fully furnished by another provider
  • Was beneficiary inpatient?
B20 M115 N211
  • Procedure/service was partially or fully furnished by another provider.
  • This item is denied when provided to this patient by a non-contract or non-demonstration supplier.

 

Last Updated Thu, 10 Jun 2021 19:42:56 +0000