Claim Adjustment Reason Codes - Palmetto GBA

ReasonCodesN115N116N117N118N119DescriptionThis decision was based on a local medical review policy (LMRP) orLocal Coverage Determination (LCD).An LMRP/LCD provides a guide toassist in determining whether a particular item or service is covered. Acopy of this policy is available at http://www.cms.hhs.gov/mcd, or if youdo not have web access, you may contact the contractor to request acopy of the LMRP/LCD.Start: 05/30/2002 | Last Modified: 04/01/2004Notes: (Modified 4/1/04)This payment is being made conditionally because the service wasprovided in the home, and it is possible that the patient is under a homehealth episode of care. When a patient is treated under a home healthepisode of care, consolidated billing requires that certain therapyservices and supplies, such as this, be included in the home healthagency's (HHA's) payment. This payment will need to be recouped fromyou if we establish that the patient is concurrently receiving treatmentunder an HHA episode of care.Start: 06/30/2002This service is paid only once in a patient's lifetime.Start: 07/30/2002 | Last Modified: 06/30/2003Notes: (Modified 6/30/03)This service is not paid if billed more than once every 28 days.Start: 07/30/2002This service is not paid if billed once every 28 days, and the patient hasspent 5 or more consecutive days in any inpatient or Skilled /nursingFacility (SNF) within those 28 days.Start: 07/30/2002 | Last Modified: 06/30/2003Notes: (Modified 6/30/03)46