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. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
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

Next Step

  • Resubmit claim with appropriate required modifier based on DMEPOS Competitive Bidding Program
  • A telephone reopening can be conducted to add or replace a modifier in accordance with DMEPOS Competitive Bidding Program
  • A Redetermination request may be submitted with all relevant supporting documentation. Review applicable Local Coverage Determination (LCD), LCD Policy Article, and documentation checklists prior to submitting request. Noridian encourages redeterminations be submitted using the Noridian Medicare Portal

How to Avoid Future Denials


Last Updated Fri, 31 Jan 2020 14:26:02 +0000