Reason Code 5J504
Need For Service/Item Not Medically and Reasonably Necessary. Claim information received does not support medical need/level of service provided.
A Redetermination request may be submitted if facility feels that sending additional documentation will support need for service(s) provided. Redetermination should include:
- All applicable supporting medical documentation
- Corrected UB-04 form
Resource: Remittance Advice Remark Code List.