Top claim denials (October - December 2025)

1

18

Exact duplicate claim/service.

N522

Duplicate of a claim processed, or to be processed, as a crossover claim.

Check claim status through the Novitasphere, the IVR or your remittance advice to determine if another claim was paid or is currently being processed.

To prevent duplicate denials, allow 14-29 days to process a claim before resubmitting.

Reference:

2

22

This care may be covered by another payer per coordination of benefits.

MA92

Missing plan information for other insurance.

Medicare is the secondary payer, and the claim must be sent to primary insurer first.

Review item 11c of the CMS-1500 Form or the EDI equivalent:

Reference:

3

26

Expenses incurred prior to coverage.

N/A

N/A

Verify patient eligibility using Novitasphere

4

29

The time limit for filing has expired

N211

The time limit for filing your claim has expired, therefore, appeal rights are not applicable for this claim.

Medicare claims must be filed to the MAC no later than 12 months, or 1 calendar year, from the date the services were furnished. This includes resubmitting corrected claims that were unprocessable

References:

5

50

These are non-covered services because this is not deemed medically necessary by the payer.

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.

Please ensure to follow Medicare guidelines, national and local coverage determinations for the service billed.

References:

6

96

Non-covered charges.

N425

Statutorily excluded services.

Prior to performing or billing a service, ensure the service is covered under Medicare.

References:

7

97

The benefit for this service is included in the payment/allowance for another procedure or service that has already been paid.

M80

Not covered when performed during the same session/date as a previously processed service for the patient.

Medicare does not pay for this service because it is part of another service that was performed at the same time. The patient should not be billed separately for this service.

8

97

The benefit for this service is included in the payment/allowance for another procedure or service that has already been paid

M144

The cost of care before and after the surgery or procedure is included in the approved amount for that service.

Evaluation and management (E/M) services related to the surgery and conducted during the post-op period are considered not separately payable.

If a modifier is applicable to the claim, apply the appropriate modifier and resubmit the claim.

References:

9

109

Claims not covered by this payer/contractor.
You must send the claim to the correct payer/contractor.

N/A

N/A

This denial indicates that the service is one that is processed or paid by another contractor.

Examples of these types of service are:

You must send the claim to the correct payer/contractor. Please verify patient information using Novitasphere or contact the patient for additional information.

10

170

Payment is denied when performed/billed by this type of provider

N/A

N/A

Provider is not eligible to perform the service being billed.

11

B9

Patient is enrolled in a hospice

N/A

N/A

This denial indicates the patient is enrolled in hospice for the date of service billed.

Verify patient information using the Novitasphere or contact the patient for additional information.

References:

12

B15

This service/procedure requires that the qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received or adjudicated.

M80

Not covered when performed during the same session/date as a previously processed service for the patient.

Review all of the services billed on the date of service for the rendering physician.

Review the NCCI PTP Coding edits on the CMS website. Determine if a modifier is appropriate with the code pair.

References: