Reason Code 151 | Remark Codes M3 M25

Code Description
Reason Code: 151 Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.
Remark Code:
M3 and M25

Equipment is the same or similar to equipment already being used.

The information furnished does not substantiate the need for this level of service. If you believe the service should have been fully covered as billed, or if you did not know and could not reasonably have been expected to know that we would not pay for this level of service, or if you notified the patient in writing in advance that we would not pay for this level of service and he/she agreed in writing to pay, ask us to review your claim within 120 days of the date of this notice. If you do not request an appeal, we will, upon application from the patient, reimburse him/her for the amount you have collected from him/her in excess of any deductible and coinsurance amounts. We will recover the reimbursement from you as an overpayment.

 

Common Reasons for Denial

  • Item billed is same or similar to an item already received in beneficiary's history

Next Step

  • 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

  • Prior to providing equipment, an Advance Beneficiary Notice of Noncoverage (ABN) may be obtained for items a supplier knows a beneficiary does not qualify for
  • To verify if beneficiary has/has not had a same or similar item in the past, suppliers may call Noridian Interactive Voice Response (IVR) or use the Noridian Medicare Portal

 

Last Updated Apr 18, 2018