N115RARCTypically appealable
What it means
This Medicare decision was based on a Local Coverage Determination — a regional Medicare policy that defines when an item or service is covered.
Official X12 description
“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. A copy of this policy is available at www.cms.gov/mcd, or if you do not have web access, you may contact the contractor to request a copy of the LCD.”
Typical cause
A Medicare contractor applied its regional LCD policy to your claim.
What to do next
- 1Look up the relevant LCD in the Medicare Coverage Database (cms.gov/mcd) to see the coverage criteria.
- 2If your situation meets the criteria, your provider can submit supporting documentation and appeal.
This denial code is typically appealable. If it applies to your claim, you can scaffold an appeal letter matched to your plan type.
Start an appeal letter