Reason Code 4 | Remark Codes M114 N565 - JA DME
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
- Is the beneficiaries permanent address with Social Security in a CBA?
- Beneficiary’s permanent address can be found under the eligibility tab of the Noridian Medicare Portal
- When beneficiary’s permanent address is in a CBA, services must be provided by a competitive bid contracted supplier
- Correct claim with appropriate required modifier based on DMEPOS Competitive Bidding Program and resubmit claim when applicable
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 Dec 09 , 2023
