How do I resolve a CO-96+N180 denial?

If billed incorrectly (such as inadvertently omitting a required modifier), request a reopening. Utilize the Noridian Modifier Lookup Tool to ensure proper modifiers are included on claim If is for the KX, GA, GZ, or GY modifiers, 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. Contact the Provider Contact Center for explanation if cannot resolve

Can I appeal a CO-96+N180 denial?

CO-96+N180 denials are generally not appealable. Non-covered charge(s). Item does not meet the criteria for the category under which it was billed.

835 Denial Combination

CO-96+N180

Contractual Obligation · Service-Line Level Adjustment

What This Combination Means

Non-covered charge(s). Item does not meet the criteria for the category under which it was billed.

N/A

Appeal Success

7-14 days

Avg. Resolution

Medium

Difficulty

Appealable

Step-by-Step Resolution

Steps tailored specifically to this CO-96+N180 combination — not generic advice.

1
If billed incorrectly (such as inadvertently omitting a required modifier), request a reopening. Utilize the Noridian Modifier Lookup Tool to ensure proper modifiers are included on claim
2
If is for the KX, GA, GZ, or GY modifiers, 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.
3
Contact the Provider Contact Center for explanation if cannot resolve

Specialty Context

How CO-96+N180 typically presents across different practice types.

Dental

Medical

Behavioral Health

Individual Code References

View the standalone definition for each code in this combination.

CARC 96 RARC N180

Medicare Contractor Guidance for CARC 96

FCSO + Noridian

This denial is received when the service billed is statutorily excluded from coverage under the Medicare program. Payment cannot be made for the service under Part A or Part B.

How to Prevent CARC 96 Denials

✓
Review the service billed to ensure the correct code was submitted.
✓
If the claim is being submitted for statutorily excluded services, you can append a GY modifier to the line item. The GY modifier indicates that the item or service is statutorily excluded or does not meet the definition of a Medicare benefit.

Items & Services Not Covered Under MedicareStatutory exclusion from Medicare benefits - §1862(a)Noridian Medicare PortalCompetitive Bid HCPCS Lookup ToolCBA Zip Code Lookup ToolNMPModifier Lookup Tool

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