Medical Necessity/No Payable Diagnosis

CARC/RARC Description
CO-50 These are non-covered services because this is not deemed a 'medical necessity' by the payer. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
N115 This decision was based on a Local Coverage Determination (LCD). An LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy is available at https://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx, or if you do not have web access, you may contact the contractor to request a copy of the LCD.

 

Common Reasons for Message

  • Missing diagnosis that supports medical necessity

Next Step

  • View medical documentation to determine that appropriate diagnosis code was submitted
  • Submit Appeal request - Items or services with this message have appeal rights
    • See Appeals webpage for instructions on how to submit a Reopening or Redetermination request

Claim Submission Tips

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

 

Last Updated May 21, 2018