Reason Code 151 | Remark Code N115

Code Description
Reason Code: 151 Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.
Remark Code: N115 This decision was based on a Local Coverage Determination (LCD).


Common Reasons for Denial

  • There is a date span overlap or overutilization based on related LCD.
  • Policy frequency limits may have been reached, per LCD

Next Step

  • To adjust date span based on medical records available to supplier, suppliers may do a self-service reopening in the Noridian Medicare Portal
  • 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 (Required for dates of service prior to January 1, 2023 only)
  • 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.

How to Avoid Future Denials


Last Updated Thu, 01 Dec 2022 20:47:39 +0000