Reason Code 7R176

Reason Code Narrative

Documentation does not support the medical necessity of the service billed.

Common Reason Code Errors

  • Documentation does not support medical necessity of service

Common Reason Code Corrections

  • Review your Recovery Audit Contractor (RAC) findings letter compared with the documents submitted to the RAC for review.
  • A Redetermination may be submitted if provider feels that sending in additional documentation will support need for service(s). The redetermination should include:
    • All applicable supporting medical documentation
    • Corrected UB-04 claim form
  • Review National Coverage Determination (NCD) and the Local Coverage Determination (LCD) as applicable.
  • Direct Data Entry (DDE) users can view remarks section for additional clarification.



Last Updated Jul 12 , 2022