Reason Code B15 | Remark Code N674 - JA DME
Browse by Topic
- Advance Beneficiary Notice of Noncoverage (ABN)
- Competitive Bidding
- DMEPOS Benefit Categories
- DMEPOS Payment Categories
- Documentation
- Emergencies and Disasters (COVID-19)
- Enrollment
- Extrapolation
- Fraud and Abuse
- Modifiers
- Noncovered Items
- Noridian Medicare Portal (NMP)
- Remittance Advice (RA)
- Repairs, Maintenance and Replacement
- Same or Similar Chart
- Upgrades
Reason Code B15 | Remark Code N674
Code | Description |
---|---|
Reason Code: B15 | This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated. |
Remark Codes: N674 | Not covered unless a pre-requisite procedure/service has been provided. |
Common Reasons for Denial
- There was not a Part B practitioner claim on file with the same date of service as this claim for DME item. This item was furnished by a Non-Contract Physician or Other Treating Practitioner, Physical Therapist, or Occupational Therapist for a competitive bid item and must meet certain requirements
Next Step
- Ensure Part B practitioner claim has processed and paid prior to appealing
- A redetermination request may be submitted with all relevant supporting documentation. Noridian encourages Redeterminations/Appeals be submitted using the Noridian Medicare Portal.
- Review applicable Non-Contract Suppliers and Exceptions under the tips section of the Competitive Bidding page prior to submitting request.
- The OTS back brace or OTS knee brace must be furnished by the non-contract physician or other treating practitioner to his or her own patient as part of his or her professional service
- Must be office visit, surgery is not included
- Must be medically necessary and applied for use prior to surgery
- Claims must have the same date of service as the professional office visit or physical/occupational therapy service that is billed to the Part B MAC. The billable office visit is an absolute requirement
- Brace must be medically necessary to be worn at home prior to surgery
- If medical need does not exist until after surgery, a competitive bid contractor must supply brace
- Must be office visit, surgery is not included
- If these requirements are not met the brace will be denied
- The OTS back brace or OTS knee brace must be furnished by the non-contract physician or other treating practitioner to his or her own patient as part of his or her professional service
How to Avoid Future Denials
- Ensure Part B practitioner claim for office visit is billed with same date of service as providing brace
Last Updated Tue, 20 Sep 2022 20:12:29 +0000