Decision based on a National Coverage Determination
Medicare applied a National Coverage Determination (NCD) and the service did not meet its conditions.
Usual causes
- Diagnosis or clinical indication not in the NCD.
- Frequency or setting conditions of the NCD not met.
- Covered indication documented but not coded.
The fix
Read the NCD in the Medicare Coverage Database. Correct the claim if a covered indication was left off; otherwise appeal with records that show the conditions are met, or bill the patient with GA when an ABN was signed.
Appeal or corrected claim?
Appeal with records; corrected claim for incomplete coding.
Deadline to watch
Medicare redetermination: 120 days from the remittance date.
Exact limits are in your payer contract or provider manual. When in doubt, send the correction or appeal this week.
N386 in short
What does N386 mean?
Medicare applied a National Coverage Determination (NCD) and the service did not meet its conditions. The official X12 text reads: "This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered. Visit CMS.gov and search for Medicare Coverage Database to find a copy of the policy."
What usually causes a N386 denial?
Diagnosis or clinical indication not in the NCD. Frequency or setting conditions of the NCD not met. Covered indication documented but not coded.
How do I fix N386?
Read the NCD in the Medicare Coverage Database. Correct the claim if a covered indication was left off; otherwise appeal with records that show the conditions are met, or bill the patient with GA when an ABN was signed.
Should I appeal N386 or send a corrected claim?
Appeal. Appeal with records; corrected claim for incomplete coding.
What deadline applies to N386?
Medicare redetermination: 120 days from the remittance date.