Reason Code 50 | Remark Code N130

Code Description
Reason Code: 50 These are non-covered services because this is not deemed a 'medical necessity' by the payer.
Remark Code: N130 Consult plan benefit documents/guidelines for information about restrictions for this service.

Common Reasons for Denial

  • Specific ICD-10 required
  • KX modifier required
  • Claim billed as upgrade and ABN was obtained. Beneficiary is liable

Next Step

  • If the remittance advice reason includes MA130, correct claim and rebill
  • Request a self service reopening in the Noridian Medicare Portal if a clerical error occurred (missing or incorrect Diagnosis code)
  • A Redetermination request may be submitted to add, change or remove the KX modifier or other specific complex modifiers. Include all required documentation for review 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
  • Collect amount from beneficiary if not paid previously for upgrade, beneficiary liable

How to Avoid Future Denials

  • Verify that the diagnosis code is correct
  • Verify the required modifiers are appended to the HCPC codes submitted. The Modifier Lookup Tool may be utilized to verify proper modifiers that may be appended to claim
Last Updated Dec 20 , 2023