Reason Code 151 | Remark Codes M3 M25 - JD DME
Reason Code 151 | Remark Codes M3 M25
|Reason Code: 151||Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.|
|Remark Code: M3 and M25||
Equipment is the same or similar to equipment already being used.The information furnished does not substantiate the need for this level of service. If you believe the service should have been fully covered as billed, or if you did not know and could not reasonably have been expected to know that we would not pay for this level of service, or if you notified the patient in writing in advance that we would not pay for this level of service and he/she agreed in writing to pay, ask us to review your claim within 120 days of the date of this notice. If you do not request an appeal, we will, upon application from the patient, reimburse him/her for the amount you have collected from him/her in excess of any deductible and coinsurance amounts. We will recover the reimbursement from you as an overpayment.
Common Reasons for Denial
- Item billed is same or similar to an item already received in beneficiary's history
- 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.
How to Avoid Future Denials
- 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
- The Noridian Medicare Portal can be accessed under Same or Similar , option 2, to verify if beneficiary has had same or similar item or call the Noridian Interactive Voice Response (IVR) System at 866-419-9458 for Same or Similar
Last Updated Mon, 21 Dec 2020 22:13:17 +0000