Reason Code 176 | Remark Code N115

Code Description
Reason Code 176 Prescription is not current
Remark Code N115 Based on local medical review policy (LMRP) or LOCA ( LCD). And LMRP/LCD provides a guide to assist in determining whether covered. A copy of this policy is available at https://www.cms.gov

 

Common Reasons for Denial

  • A recent break in medical need
  • 13/15 months have been paid
  • Same and Similar equipment on file

Next Step

  • If a break in need, resubmit claim with a narrative
  • Request an extension of an existing CMN to allow payment if 13/15 payment have not been paid
  • If patient had previous equipment, resubmit with narrative on status of old equipment

How to Avoid Future Denials

  • If a break in medical need, attach a comment with claim submission
  • Verify number of payments prior to submission of claim
  • Verify if same equipment on file prior to submission of claim

 

Last Updated Dec 14, 2018