How do I resolve a CO-50+N115 denial?

Identify the specific LCD number from the denial notice or by searching the CMS Coverage Database for the procedure code. Review the LCD's covered indications list — note which ICD-10 codes support coverage. Compare the submitted diagnosis codes to the covered indications list. If the patient has a covered diagnosis that was omitted, correct the ICD-10 code(s) and resubmit as a corrected claim. If the patient's condition does not meet any covered indication, prepare a medical necessity appeal with clinical documentation explaining why the service was needed despite the diagnosis limitation. Attach the treating provider's clinical notes supporting the necessity of the service for this patient's specific condition.

Can I appeal a CO-50+N115 denial?

Yes. CO-50+N115 denials are typically appealable with a 65% success rate. Resolution difficulty is Medium and typically takes 14-30 days.

835 Denial Combination

CO-50+N115

Contractual Obligation · Service-Line Level Adjustment

What This Combination Means

Medical necessity denial based on a Local Coverage Determination (LCD). N115 confirms: this service is not covered for the submitted diagnosis per the applicable LCD. The LCD defines which ICD-10 codes support coverage for the procedure. The denial is correctable if the patient has a covered diagnosis that was not included on the claim.

65%

Appeal Success

14-30 days

Avg. Resolution

Medium

Difficulty

Yes

Appealable

Step-by-Step Resolution

Steps tailored specifically to this CO-50+N115 combination — not generic advice.

1
Identify the specific LCD number from the denial notice or by searching the CMS Coverage Database for the procedure code.
2
Review the LCD's covered indications list — note which ICD-10 codes support coverage.
3
Compare the submitted diagnosis codes to the covered indications list.
4
If the patient has a covered diagnosis that was omitted, correct the ICD-10 code(s) and resubmit as a corrected claim.
5
If the patient's condition does not meet any covered indication, prepare a medical necessity appeal with clinical documentation explaining why the service was needed despite the diagnosis limitation.
6
Attach the treating provider's clinical notes supporting the necessity of the service for this patient's specific condition.

Specialty Context

How CO-50+N115 typically presents across different practice types.

Dental

LCDs are primarily a Medicare issue. For dental procedures covered under medical (e.g., oral surgery), confirm the ICD-10 code meets the LCD coverage criteria.

Medical

Pull the specific LCD from the MAC website (cms.gov/medicare-coverage-database). Confirm which ICD-10 codes are covered indications. If the patient has a covered diagnosis not included on the original claim, resubmit with the correct ICD-10.

Behavioral Health

LCDs for behavioral health procedures (e.g., psychological testing) define covered indications. Verify the submitted diagnosis is on the covered diagnosis list and that the code is specific enough (e.g., F41.1 vs. F41.9).

Individual Code References

View the standalone definition for each code in this combination.

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