N115 remark code

Remittance advice remark code N115. Remark codes add detail to the reason code on the same claim line.

Decision based on an LCD

Unofficial reference. This is our own plain-English explanation, not the official code text. Payer rules differ. Verify with the payer and the official X12 code list. AlphaPrefix is not affiliated with X12, CMS or any payer. Data last updated Nov 11, 2026.

What N115 means

The determination came from a Local Coverage Determination, the regional Medicare policy for when a service is covered.

Medicare contractors publish Local Coverage Determinations listing the diagnoses, frequency limits and documentation needed for many services. N115 tells you the claim was judged against one of those policies.

It explains the reason code on the claim, often 50 or 167. The LCD and its billing article usually show exactly which diagnosis or condition was missing.

Common causes

• The diagnosis on the claim is not on the LCD's list of covered conditions.
• Frequency or utilization limits in the LCD were exceeded.
• Documentation required by the LCD was not provided.
• The billing article for the LCD requires a modifier or code pairing that was missing.

What to do next

1. Look up the LCD and billing article that apply to the code and service location.
2. Check the record for a covered diagnosis that was not coded or was coded too vaguely.
3. Correct the claim if coding was the problem, or appeal with documentation if the criteria were met.
4. Check whether an advance notice was signed before shifting any balance to the patient.

Related codes

• N386 (remark code) Decision based on an NCD
• 50 (reason code) Not medically necessary per the payer
• N569 (remark code) Not covered for the diagnosis