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

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
    • If these requirements are not met the brace will be denied

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