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Last Modified: 9/28/2022 Location: FL, PR, USVI Business: Part A

Denial reason codes 54NCD or 53NCD FAQ

Q: I’m receiving one of the denial reason codes 54NCD or 53NCD, so what steps can I take to avoid this reason code?
A: You’re receiving one of these reason codes when the procedure code is billed with an incompatible diagnosis for payment purposes, and the ICD-10 code submitted isn’t covered under an LCD or NCD.
You receive 54NCD when billed without the GA modifier, making the provider liable. You receive 53NCD when billed with the GA modifier, making the beneficiary liable.
You can avoid these reason codes by reviewing and applying all applicable LCDs and NCDs for the services being performed and billed. LCDs and NCDs are medical policies that provide coverage criteria and documentation requirements. NCDs are national policies that apply to all jurisdictions in the Medicare Program and LCDs are local policies that apply to a particular jurisdiction.
How to search for medical policies:
Search by keyword, code, or document ID
LCDs: First Coast’s interactive LCD index
Search by LCD ID, keyword (title only), or HCPCS code
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.