Reason Code 16 | Remark Code M124

Code Description
Reason Code: 16 Claim/service lacks information or has submission/billing error(s) which is needed for adjudication.
Remark Code: M124 Missing indication of whether the patient owns the equipment that requires the part or supply.

 

Common Reasons for Denial

  • Item billed does not have base equipment on file. Main equipment is missing therefore Medicare will not pay for accessories or supplies

Next Step

  • A telephone reopening should be conducted to add beneficiary owned equipment for items that require accessories or supplies. Information to provide is, HCPCS code of base equipment owned and date equipment purchased. Examples of the items are Positive Airway Pressure (PAP) devices, BiPAPs, nebulizers, all glucose monitors, and humidifiers, etc. Call the Supplier Contact Center at 877-320-0390
  • A written reopening may also be submitted with all beneficiary owned equipment information, HCPCS code of base equipment owned and date equipment purchased. This can be accomplished through mail, fax or Noridian Medicare Portal through the appeals function.

How to Avoid Future Denials

  • Suppliers can check Same or Similar on the Noridian Medicare Portal or through the Noridian Interactive Voice Response (IVR) System to ensure that beneficiary owned equipment is on file prior to submitting claims for accessories or supplies.
  • If base item is not on file with Noridian, add a narrative to each claim line. Add a narrative to each claim line in Item 19 on CMS-1500 form or in 2400 loop NTE segment for electronic claims. Narrative should include HCPCS code of base equipment and a notation that the beneficiary owns the equipment with month and year beneficiary purchased equipment. i.e. Beneficiary owned E0601; purchased June 2015

 

Last Updated Tue, 23 Feb 2021 17:47:01 +0000