Reason Code 150 | Remark Codes N115

Code Description
Reason Code: 150 Payer deems the information submitted does not support this level of service.
Remark Codes: N115 This decision was based on a Local Coverage Determination (LCD).

 

Common Reasons for Denial

  • Policy frequency limits may have been reached, per LCD

Next Step

  • Review claim submitted for frequency limits listed in LCD and Policy Article and either adjust amounts because of supplier liable or appeal claim with documentation to support medical need
  • Review Medically Unlikely Edit (MUE) tool for maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service.
  • Ensure all questions on Certificate of Medical Necessity (CMN) are qualifying
  • A Redetermination request may be submitted with all relevant supporting documentation. Noridian encourages Redeterminations/Appeals be submitted using the Noridian Medicare Portal. 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 Thu, 14 Oct 2021 18:44:22 +0000