Reason Code 50 | Remark Code N115

Code Description
Reason Code: 50 These are non-covered services because this is not deemed a 'medical necessity' by the payer. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
Remark Code: N115 This decision was based on a Local Coverage Determination (LCD). An LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy is available at http://www.cms.gov/mcd, or if you do not have web access, you may contact the contractor to request a copy of the LCD.

 

Common Reasons for Denial

  • Item billed may require a specific diagnosis or modifier code based on related LCD
  • A development letter requesting additional documentation to support service billed was not received within provided timeline
  • Item being billed does not meet medical necessity

Next Step

  • A telephone reopening can be conducted to adjust diagnosis based on medical records available to supplier.
  • A Redetermination request may be submitted with all applicable 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

  • Review beneficiary's records to determine if a diagnosis that qualifies is indicated
  • Review related LCD for modifier criteria
  • Respond to development letters with supporting documentation within designated timeline as defined on letter
  • Ensure all questions on Certificate of Medical Necessity (CMN) are qualifying according to policy
  • 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

 

Last Updated Apr 18, 2018