Reason Code 50 | Remark Code N180

Code Description
Reason Code: 50 These are non-covered services because this is not deemed a 'medical necessity' by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
Remark Code: N180 This item or service does not meet the criteria for the category under which it was billed.

 

Common Reasons for Denial

  • Claim is missing a Certification of Medical Necessity or DME Information Form.
  • Claim is missing the KX modifier.
  • This is not a service covered by Medicare.

Next Step

  • If CMN/DIF was submitted with claim, send a request with supporting documentation to Redeterminations.
  • If the KX modifier was omitted by mistake, request a redetermination to add, change, or remove the KX (the same is true for GA, GZ, GY modifiers). Be sure to include all the appropriate documentation.
  • A redetermination request may be submitted with all applicable supporting documentation. Review the applicable Local Coverage Determination (LCD), LCD Policy Article, and documentation checklists prior to submitting the redetermination. Noridian encourages redeterminations be submitted using the Noridian Medicare Portal.

How to Avoid Future Denials

  • Check Local Coverage Determination and Policy Article.

 

Last Updated Nov 29, 2018