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. Request should include:
- All applicable supporting medical documentation
- Corrected UB-04 form
View reason code list, return to Reason Code Guidance page.
Last Updated May 22, 2018