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Reason Code B15 | Remark Codes M114 - JD DME

Reason Code B15 | Remark Codes M114

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: M114 This service was processed in accordance with rules and guidelines under the DMEPOS Competitive Bidding Program or a Demonstration Project.

 

Common Reasons for Denial

Next Step

  • Appeal claim, 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 Competitive Bidding requirements prior to submitting request.
    • The OTS back brace or OTS knee brace must be furnished by the physician or other treating practitioner to his or her own patient as part of his or her professional service.
      • Brace must be medically necessary to be worn at home prior to surgery
      • Claims must have the same date of service as the office visit or surgery date
      • Or if furnished as part of an unbillable follow-up visit during a surgical post-operative period related to recovery, the claim should be billed with the same date of service or noted as applying to the same date as the surgery
    • Claim must include narrative of surgery date. Narrative example DOS 05/01/23
      • Item 19 of the 1500 claim form or the 2400/NTE segment of an electronic claim

How to Avoid Future Denials

  • Ensure Part B practitioner claim for office visit is billed with same date of service as providing brace
    • Claims must have the same date of service as the office visit or surgery date
    • Or if furnished as part of an unbillable follow-up visit during a surgical post-operative period related to recovery, the claim should be billed with the same date of service or noted as applying to the same date as the surgery
    • Claim must include narrative of surgery date. Narrative example DOS 05/01/23
      • Item 19 of the 1500 claim form or the 2400/NTE segment of an electronic claim

 

Last Updated Wed, 14 Jun 2023 15:22:18 +0000