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N115 Remark Code: Decision Based on an LCD

N115 means the payment decision was based on a Local Coverage Determination (LCD), a Medicare contractor's policy describing when a service is considered reasonable and necessary. The claim did not meet the LCD's criteria as submitted.

Code: N115 (RARC N115)
Status: Active In use since May 30, 2002; last modified July 1, 2010.
Code set: Remittance Advice Remark Codes (RARC)
Group codes: CO (Contractual Obligation): The service was denied under the LCD and the provider is liable, typically because no valid advance beneficiary notice (ABN) was obtained.
PR (Patient Responsibility): The patient is responsible when a valid ABN was signed before the service and the claim carried the appropriate modifier.
Official 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.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified: September 24, 2026 against the official X12 list.

What N115 means

Medicare Administrative Contractors publish Local Coverage Determinations that spell out when services are covered in their jurisdictions: which diagnoses support them, how often they can be done, and what the record must show. Each LCD is usually accompanied by a billing and coding article. N115 tells you the contractor applied one of these policies and the claim did not satisfy it.

The most common pairing is CO-50 with N115. The remark also works with diagnosis, frequency, and non-covered reason codes.

Common causes

A diagnosis code the LCD lists as supporting coverage was not on the claim, or was not linked to the line in CMS-1500 box 24E.
The service was performed more often than the LCD allows.
Documentation the LCD requires, such as test results or prior treatment, was missing.
The claim used a diagnosis code that was valid but not specific enough for the policy.

How to fix it

Pull the LCD and its article for the date of service, and list the criteria that apply to the code billed.
Compare the chart with each criterion.
If a coding error caused the denial, correct the diagnosis or pointer and send a corrected claim with resubmission code 7 in box 22 plus the original claim number.
If the record meets the policy, file a redetermination with the notes and a short cover letter citing the LCD sections met.
If the policy was not met, check for an ABN before deciding whether to bill the patient.

How to prevent it

Review LCDs for your high-volume services and build their covered diagnoses and frequency limits into order entry and pre-billing checks. When coverage is uncertain, obtain an ABN before the service.

Codes that may appear with N115

CO-50 (These are non-covered services because this is not deemed a 'medical necessity' by the payer.): Not medically necessary; N115 says the LCD was the basis for that decision.
CO-167 (This (these) diagnosis(es) is (are) not covered.): The diagnosis billed is not among those the LCD covers.
CO-151 (Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.): Frequency limits in the LCD were exceeded.
CO-96 (Non-covered charge(s).): A non-covered charge with the LCD as the explanation.

N386 (This decision was based on a National Coverage Determination (NCD).): The national equivalent, used when a National Coverage Determination drove the decision.
M25 (The information furnished does not substantiate the need for this level of service.): The information furnished does not support the level of service billed.
N130 (Consult plan benefit documents/guidelines for information about restrictions for this service.): Points commercial plan members to plan benefit documents for restrictions.

N115 FAQ

Where do I find the LCD?

The official remark points to the CMS Medicare Coverage Database at www.cms.gov/mcd. You can also ask the contractor for a copy. Look for the LCD and its billing and coding article that were in effect on the date of service.

What if the diagnosis supports coverage but wasn't coded?

If the record documents a covered condition that was left off the claim, send a corrected claim with the accurate diagnosis codes. If the record does not support it, the codes cannot be added.

Can the patient be billed?

Only if a valid ABN was signed before the service. Without one, the provider generally absorbs the denied amount.

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