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