Reason Code 5J504

Published 02/28/2022

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.

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