Reason Code 50 | Remark Code N130

Code Description
Reason Code: 50 Item billed does not meet medically necessity
Remark Code: N130 Non Covered item

 

Common Reasons for Denial

  • Does item require DIF or CMN
  • Specific ICD-10 required
  • KX modifier required

Next Step

  • If a DIF or CMN is required, submit request to Redeterminations with required CMN or DIF
  • Request a reopening if a clerical error occurred. ( missing or incorrect Diagnosis code)
  • Request a redermination to add, change or remove the KX or any modifier change. Include all required documentation for review

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

 

Last Updated Dec 14, 2018