Reason Code 50 | Remark Code N180

Code Description
Reason Code: 50 These are non-covered services because this is not deemed a 'medical necessity' by the payer.
Remark Code: N180 This item or service does not meet the criteria for the category under which it was billed.

 

Common Reasons for Denial

  • Claim is missing a Certificate of Medical Necessity or DME Information Form.
  • Claim is missing the KX modifier.
  • This is not a service covered by Medicare.

Next Step

  • If the remittance advice reason includes MA130, correct claim and rebill
  • If CMN/DIF was submitted with claim, 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.
  • If the KX modifier was omitted by mistake, request a Redeterminations/Appeals to add, change, or remove the KX (the same is true for GA, GZ, GY modifiers). Be sure to include all the appropriate documentation.

How to Avoid Future Denials

 

Last Updated Thu, 10 Dec 2020 15:08:19 +0000