N115: This decision was based on a Local Coverage Determination (LCD)
The payer denied or reduced payment because the service did not meet the medical necessity criteria in that Medicare Administrative Contractor's published Local Coverage Determination for this code.
Corrective actions
- 1
Pull the specific LCD
Look up the LCD cited (or the LCD applicable to the code and jurisdiction) on the MAC's website and compare its coverage criteria and covered ICD-10 codes to the documentation on file.
- 2
Append missing diagnosis or documentation and appeal
If the medical record actually supports the LCD's criteria but the claim was coded incompletely, submit a corrected claim or redetermination request with the qualifying diagnosis code and supporting clinical notes.
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Retrieved 2026-07-18.
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DenialPath provides billing and administrative guidance based on published CMS and X12 sources. It is not medical advice, not a coverage determination, and not a guarantee of payment. NCCI and MUE edits are republished quarterly and payer policies vary by contract. Always confirm against the payer's own current policy before submitting or appealing.