How do I resolve a CO-151+N115 denial?

To adjust date span based on medical records available to supplier, suppliers may do a self-service reopening in the Noridian Medicare Portal Review claim submitted for frequency limits listed in LCD and Policy Article and either adjust amounts because of supplier liable or appeal claim with documentation to support medical need Review Medically Unlikely Edit (MUE) tool for maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service. A Redetermination request may be submitted with all relevant supporting documentation. Noridian encourages Redeterminations/Appeals be submitted using the Noridian Medicare Portal. Review applicable Local Coverage Determination (LCD), LCD Policy Article, and Documentation Checklists prior to submitting request.

835 Denial Combination

CO-151+N115

Contractual Obligation · Service-Line Level Adjustment

What This Combination Means

Policy frequency limits may have been reached, per LCD There is a date span overlap or overutilization based on related LCD.

N/A

Appeal Success

7-14 days

Avg. Resolution

Medium

Difficulty

Appealable

Step-by-Step Resolution

Steps tailored specifically to this CO-151+N115 combination — not generic advice.

1
To adjust date span based on medical records available to supplier, suppliers may do a self-service reopening in the Noridian Medicare Portal
2
Review claim submitted for frequency limits listed in LCD and Policy Article and either adjust amounts because of supplier liable or appeal claim with documentation to support medical need
3
Review Medically Unlikely Edit (MUE) tool for maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service.
4
A Redetermination request may be submitted with all relevant supporting documentation. Noridian encourages Redeterminations/Appeals be submitted using the Noridian Medicare Portal. Review applicable Local Coverage Determination (LCD), LCD Policy Article, and Documentation Checklists prior to submitting request.

Specialty Context

How CO-151+N115 typically presents across different practice types.

Dental

Medical

Behavioral Health

Individual Code References

View the standalone definition for each code in this combination.

CARC 151 RARC N115

Medicare Contractor Guidance for CARC 151

Noridian

Equipment is the same or similar to equipment already being used. There is a date span overlap or overutilization based on related LCD.

How to Prevent CARC 151 Denials

✓
For frequency guidelines, refer to applicable Local Coverage Determination (LCD), LCD Policy Article
✓
Review Medically Unlikely Edit (MUE) tool for maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service.
✓
To verify if beneficiary has/has not had a same or similar item in the past, suppliers may use the Noridian Medicare Portal or Noridian Interactive Voice Response (IVR) System
✓
Prior to providing equipment, an Advance Beneficiary Notice of Noncoverage (ABN) may be obtained for items a supplier knows a beneficiary does not qualify for
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Is there a similar rental item renting and billing in supplier’s system that has not been returned?
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Stop rental item, amounts on AR will need to be adjusted
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Was there a previous supplier within the RUL, and did that supplier continue to bill rental after returned?
✓
Adjust amount from AR for that month, ensure that rental was picked up from beneficiary (two suppliers cannot be reimbursed for same month)
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Was item lost, stolen or irreparably damaged (specific incident)?
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Append RA modifier to claim
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Appeal if denied and provided for lost, stolen, or irreparably damaged (specific incident) with documentation from beneficiary statement, police report, fire report, or insurance claim information, etc. as applicable
✓
If providing prior to end of RUL for change in medical condition, may obtain an ABN
✓
Appeal if denied and provided for change in medical condition with medical records to substantiate need
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If appeal is upheld/denied, write off amount from AR
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Are there rental items billing as upgrades and are they billing correctly each month with appropriate modifiers?
✓
Refer to the upgrade process on the Noridian Medicare website

Noridian Medicare PortalIVRSame or Similar

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