Reason Code 5J504

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.
    • Redetermination should include:
      • All applicable supporting medical documentation
      • Corrected UB-04 form

Resource

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

Last Updated Fri, 11 Jun 2021 17:27:35 +0000