Reason Code 204 | Remark Code N130

Code Description
Reason Code: 204 This service/equipment/drug is not covered under the patient's current benefit plan.
Remark Code: N130 Consult plan benefit documents/guidelines for information about restrictions for this service.


Common Reasons for Denial

  • This is a noncovered item
  • Item is not medically necessary

Next Step

How to Avoid Future Denials

  • In order for an item to be covered by DME MAC, it must fall within one of ten benefit categories. Some items may not meet definition of a Medicare benefit or may be statutorily excluded


Last Updated Dec 09 , 2023