Reason Code 16 | Remark Code M124

Code Description
Reason Code: 16 Claim/service lacks information or has submission/billing error(s) which is needed for adjudication. Do not use this code for claims attachment(s)/other documentation. 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.) Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
Remark Code: M124 Missing indication of whether the patient owns the equipment that requires the part or supply.

 

Common Reasons for Denial

  • Item billed does not have base equipment on file. Main equipment is missing therefore Medicare will not pay for supplies

Next Step

  • A telephone reopening can be conducted to add beneficiary owned equipment for certain items. Items are Positive Airway Pressure (PAP) devices, BiPAPs, walkers, hospital beds, humidifiers and manual wheelchairs (K0001-K0004)
  • 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 Noridian Medicare Portal

How to Avoid Future Denials

  • Suppliers should call and verify that main equipment is on file prior to submitting claims for accessories
  • If beneficiary owns base equipment that supplies are billed for, add a narrative to claim in Item 19 on CMS-1500 form or in 2400 loop NTE segment for electronic claims. Narrative should include HCPCS code of base equipment and a notation that the beneficiary owns the equipment with month and year beneficiary purchased equipment

 

Last Updated Apr 18, 2018