| 4 || M114 |
- 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
| 13 || || |
- The date of death precedes the date 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 |
- Item(s) billed did not have a valid ordering physician name
| 16 || MA13 |
- 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 |
- 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.
| 29 || N211 || |
- The time limit for filing has expired.
- You may not appeal this decision.
| 31 || || |
- Patient cannot be identified as our insured.
| 50 || M127 || |
- Documentation requested was not received or was not received timely
| 50 || N115 || |
- Item billed may require a specific diagnosis or modifier code based on related Local Coverage Determination (LCD)
- Development letter requesting additional documentation to support service billed was not received within provided timeline
- Item being billed does not meet medical necessity
| 50 || N130 || Non covered services |
| 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 || N115 || |
- Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
- 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 at www.cms.gov/mcd, or if you do not have web access, you may contact the contractor to request a copy of the LCD.
| 97 || M2 || |
- Beneficiary was inpatient on date of service billed
| 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 || |
- Rent/purchase guidelines were not met.
- Consult plan benefit documents/guidelines for information about restrictions for this service.
| 109 || N104 || |
- Claim was submitted to incorrect Jurisdiction
| 109 || N130 || |
- Claim was submitted to incorrect contractor
| 109 || N418 || |
- Claim was billed to the incorrect contractor
- Beneficiary was enrolled in a Medicare Health Maintenance Organization (HMO) for date of service submitted
| 151 || M3 |
- 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 || |
- Item billed requires an initial Certificate of Medical Necessity (CMN) or DME Information Form (DIF) be submitted
- Initial CMN or DIF was not submitted with claim or on file with Noridian
| 176 || N115 || |
- A recent break in medical need
- 13/15 months have been paid
- Same and Similar equipment on file
| 176 || N592 || |
- Item billed requires a recertified or revised CMN or DIF to be submitted. Either a CMN/DIF 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
| 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.
| B18 || N522 || |
- Duplicate claim has already been submitted and processed
| 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.