Medical Necessity/No Payable Diagnosis - JF Part B
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 on the Medicare Coverage Database, 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
- Review CMS’ Medicare Coverage Database for applicable Local Coverage Determinations (LCDs) for the denied procedure
- 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 Active LCDs to verify diagnosis codes that support medical necessity
- If services are not medically necessary, view Advance Beneficiary Notice of Noncoverage (ABN) instructions
Last Updated Dec 09 , 2023
