Reason Code 50 | Remark Code N130

Code Description
Reason Code: 50 Item billed does not meet medical necessity
Remark Code: N130 Non-covered item


Common Reasons for Denial

  • Item requires DIF or CMN
  • Specific ICD-10 required
  • KX modifier required

Next Step

  • If the remittance advice reason includes MA130, correct claim and rebill
  • If a DIF or CMN is required, submit request to Redeterminations with required CMN or DIF
  • Request a self service reopening in the Noridian Medicare Portal if a clerical error occurred (missing or incorrect Diagnosis code)
  • A Redetermination request may be submitted to add, change or remove the KX modifier or other specific complex modifiers. Include all required documentation for review 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

  • Attach the required CMN or DIF that is required for HCPC that is being billed
  • Verify that the diagnosis code is correct
  • Verify the required modifiers are appended to the HCPC codes submitted. The Modifier Lookup Tool may be utilized to verify proper modifiers that may be appended to claim


Last Updated Thu, 23 Feb 2023 18:28:03 +0000