Reason Code 5H164: Documentation Does Not Support Medical Necessity

Published 05/20/2019

This claim was fully or partially denied because the documentation submitted for review does not support the medical necessity of some of the services billed.

To Prevent This Denial

  • Submit all documentation related to the services billed which support the medical necessity of the services
  • A legible signature is required on all documentation necessary to support orders and medical necessity
  • Use the most appropriate ICD-10-CM codes to identify the beneficiary’s medical diagnosis

More Information

Was this article helpful?