Reason Code 204 | Remark Code N130 - JA DME

Common Reasons for Denial

• This is a noncovered item
• Item is not medically necessary

Next Step

• 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

• In order for an item to be covered by DME MAC, it must fall within one of ten benefit categories. Some items may not meet definition of a Medicare benefit or may be statutorily excluded