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Last Modified: 8/25/2022 Location: FL, PR, USVI Business: Part A, Part B

Denial reason code 55503 FAQ

Q: I received denial reason code 55503. What steps can we take to avoid this reason code?
A: You received this reason code because the services were billed with a diagnosis code that doesn’t meet medical necessity according to Medicare guidelines.
You can avoid this reason code by reviewing and applying all applicable LCDs for the services being performed and billed. LCDs provide coverage criteria and documentation requirements.
How to search for medical policies:
LCDs: First Coast’s interactive LCD index
Search by LCD ID, keyword (title only), or HCPCS code
If you disagree with this denial you can request a redetermination. Please review our Appeals page for additional information. To learn more about medically reviewed claims, read our article “Identifying medically reviewed adjudicated claims.”
Did you know you can refer to our Part A reason code lookup for a description associated with the Medicare Part A reason codes? Enter a valid reason code into the box and click the submit button.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.