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Reason Code 50 | Remark Code N115 - JA DME

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.
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.


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
  • CMN is in denied status

Next Step

How to Avoid Future Denials

  • Review beneficiary's medical 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 are qualifying according to policy (Required for dates of service prior to January 1, 2023 only)
  • 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 Mon, 27 Mar 2023 13:49:08 +0000