Reason Code 151 - JD DME

Common Reasons for Denial

• Equipment is the same or similar to equipment already being used.
• There is a date span overlap or overutilization based on related LCD.

Next Step

• Review claim submitted for frequency limits listed in LCD and Policy Article and either adjust amounts because of supplier liable or appeal claim with documentation to support medical need. A Redetermination request may be submitted 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. Noridian encourages Redeterminations be submitted using the Noridian Medicare Portal
• Review Medically Unlikely Edit (MUE) tool for maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service.

How to Avoid Future Denials

• For frequency guidelines, refer to applicable Local Coverage Determination (LCD), LCD Policy Article
• Review Medically Unlikely Edit (MUE) tool for maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service.
• To verify if beneficiary has/has not had a same or similar item in the past, suppliers may use the Noridian Medicare Portal or Noridian Interactive Voice Response (IVR) System at 866-419-9458
• Prior to providing equipment, an Advance Beneficiary Notice of Noncoverage (ABN) may be obtained for items a supplier knows a beneficiary does not qualify for
• Is there a similar rental item renting and billing in supplier’s system that has not been returned?
• Stop rental item, amounts on AR will need to be adjusted
• Was there a previous supplier within the RUL, and did that supplier continue to bill rental after returned?
• Adjust amount from AR for that month, ensure that rental was picked up from beneficiary (two suppliers cannot be reimbursed for same month)
• Was item lost, stolen or irreparably damaged (specific incident)?
• Append RA modifier to claim
• Appeal if denied and provided for lost, stolen, or irreparably damaged (specific incident) with documentation from beneficiary statement, police report, fire report, or insurance claim information, etc. as applicable
• If providing prior to end of RUL for change in medical condition, may obtain an ABN
• Appeal if denied and provided for change in medical condition with medical records to substantiate need
• If appeal is upheld/denied, write off amount from AR
• Are there rental items billing as upgrades and are they billing correctly each month with appropriate modifiers?
  • Refer to the upgrade process on the Noridian Medicare website