RARC N115
Decision based on a Local Coverage Determination
The payer applied a Local Coverage Determination — a regional policy setting out when a service is covered.
Why you actually get this
- The documentation did not meet the LCD's stated criteria.
- The diagnosis reported is not on the LCD's covered list.
- The LCD changed and the practice's process did not.
How to check whether it’s correct
- 01Find the LCD and read its coverage criteria — they are published and specific.
- 02Compare the documentation against those criteria line by line.
- 03Confirm the LCD in force on the date of service, not today's version.
Usually worth appealing
Among the most winnable denials, because the criteria are written down. The appeal is not an argument about clinical judgement — it is demonstrating that the record meets a published standard. If it genuinely does not, the LCD also tells you what would have been needed next time.
Often arrives with
Seeing a lot of these?
A single denial is a claim to work. A pattern of the same denial is a process to fix, and the two need completely different responses. A free panel reads ninety days of your claims data and shows which codes actually recur for you.
Remittance Advice Remark Codes are External Code List 411, maintained by CMS and published by X12. The official description of this code is theirs and is not reproduced here. Check the authoritative list for current wording and status.