Does not meet the criteria for the category billed
The item or service was billed under a category (for example a DME class or a therapy code) whose criteria the documentation does not meet.
Usual causes
- DME billed under a higher category without the required documentation.
- Service coded to a category the record does not support.
The fix
Compare the documentation with the payer's criteria for that category. Rebill under the correct category, or appeal with documentation when the criteria are met.
Appeal or corrected claim?
Corrected claim or appeal, depending on the documentation.
Deadline to watch
Timely filing or appeal window.
Exact limits are in your payer contract or provider manual. When in doubt, send the correction or appeal this week.
N180 in short
What does N180 mean?
The item or service was billed under a category (for example a DME class or a therapy code) whose criteria the documentation does not meet. The official X12 text reads: "This item or service does not meet the criteria for the category under which it was billed."
What usually causes a N180 denial?
DME billed under a higher category without the required documentation. Service coded to a category the record does not support.
How do I fix N180?
Compare the documentation with the payer's criteria for that category. Rebill under the correct category, or appeal with documentation when the criteria are met.
Should I appeal N180 or send a corrected claim?
Correct or appeal (see note). Corrected claim or appeal, depending on the documentation.
What deadline applies to N180?
Timely filing or appeal window.