Reason Code 204 | Remark Code N130

Code Description
Reason Code: 204 This service/equipment/drug is not covered under the patient's current benefit plan.
Remark Code: N130 Consult plan benefit documents/guidelines for information about restrictions for this service.

 

Common Reasons for Denial

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

Next Step

  • A Redetermination request may be submitted with all relevant 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

  • 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

 

Last Updated Apr 18, 2018