How do I resolve a CO-B15+M51 denial?

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. Noridian encourages Redeterminations be submitted using the Noridian Medicare Portal. Suppliers may do a self-service reopening in the Noridian Medicare Portal to adjust place of service based on medical records available to supplier. Ensure drug billed is associated with administration fee. Was item eligible for coverage for date of service billed? May need to bill different program.

835 Denial Combination

CO-B15+M51

Contractual Obligation · Service-Line Level Adjustment

What This Combination Means

Administration fee billed with no drug billed within required time frame Missing/incomplete/invalid "from" date(s) of service

N/A

Appeal Success

7-14 days

Avg. Resolution

Medium

Difficulty

Appealable

Step-by-Step Resolution

Steps tailored specifically to this CO-B15+M51 combination — not generic advice.

1
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. Noridian encourages Redeterminations be submitted using the Noridian Medicare Portal.
2
Suppliers may do a self-service reopening in the Noridian Medicare Portal to adjust place of service based on medical records available to supplier.
3
Ensure drug billed is associated with administration fee.
4
Was item eligible for coverage for date of service billed? May need to bill different program.

Specialty Context

How CO-B15+M51 typically presents across different practice types.

Dental

Medical

Behavioral Health

Individual Code References

View the standalone definition for each code in this combination.

CARC B15 RARC M51

Medicare Contractor Guidance for CARC B15

Noridian

There was not a Part B practitioner claim on file with the same date of service as this claim for DME item. This item was furnished by a Non-Contract Physician or Other Treating Practitioner, Physical Therapist, or Occupational Therapist for a competitive bid item and must meet certain requirements

How to Prevent CARC B15 Denials

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The OTS back brace or OTS knee brace must be furnished by the physician or other treating practitioner to his or her own patient as part of his or her professional service
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If brace provided prior to surgery or no surgery planned, brace must be medically necessary to be worn at home prior to surgery
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Practitioners and physicians must append KV modifier to claim line in these circumstances
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If brace provided post-surgery, claim should adhere to the following guidelines:
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If brace provided after surgery, claim must have same date of service (DOS) as surgery
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If brace provided as part of an unbillable follow-up visit during post-operative period and related to recovery
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Bill with surgery DOS, or
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Bill with follow-up visit DOS and include narrative indicating brace applies to same date as surgery
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Narrative example: Brace associated with surgery DOS 05/01/2023
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Enter narrative in Item 19 of 1500 claim form or 2400/NTE segment of electronic claim

Noridian Medicare Portal

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