Reason Code 5J504 - JE Part A

Reason Code Narrative

NEED FOR SERVICE/ITEM NOT MEDICALLY AND REASONABLY NECESSARY.

Common Reason Code Errors

• Claim information received does not support medical need/level of service provided.

Common Reason Code Corrections

• A Redetermination request may be submitted if facility feels that sending additional documentation will support need for service(s) provided. Request should include:
  • All applicable supporting medical documentation
  • Corrected UB-04 form

Resource

• Remittance Advice Remark Code List

View reason code list, return to Reason Code Guidance page.