Reason Code 55405

Reason Code Narrative

THE INFORMATION PROVIDED DOES NOT SUPPORT THE NEED FOR THIS SERVICE OR ITEM. NOT MEDICALLY NECESSARY.

Common Reason Code Errors

  • Information received from Additional Document Request (ADR) does not support medical need for service(s) provided

Common Reason Code Corrections

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

Direct Data Entry (DDE) users can view remarks section for additional clarification.

Resource

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

Last Updated May 22, 2018