Reason Code 4 | Remark Codes M114 N565

Code Description
Reason Code: 4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
Remark Codes:
M114 and N565
This service was processed in accordance with rules and guidelines under the DMEPOS Competitive Bidding Program or a Demonstration Project. For more information regarding these projects, contact your local contractor.

Alert: This non-payable reporting code requires a modifier. Future claims containing this non-payable reporting code must include an appropriate modifier for the claim to be processed

 

Common Reasons for Denial

  • 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
  • Beneficiary must receive services from a competitive bid contracted supplier when their permanent address with Social Security is in a Competitive Bid Area (CBA)

Next Step

How to Avoid Future Denials

  • Check eligibility on the Noridian Medicare Portal to verify the beneficiary’s permanent address on file with the Social Security Administration prior to providing service
  • Utilize the Round 2021 CBA Zip Code Lookup Tool to verify if beneficiary’s permanent address resides in a CBA
  • Utilize the modifier charts on the Competitive Bidding page to ensure proper modifiers are included on claim

 

Last Updated Mon, 27 Feb 2023 16:11:29 +0000