RARC N115: Decision Based on a Local Coverage Determination (LCD)
RARC N115 means the payment decision was based on a Local Coverage Determination (LCD) — a Medicare contractor policy defining when an item or service is covered. It rides with CO-50 or CO-96. The fix is reading the cited LCD and confirming the diagnosis, documentation, and coverage criteria match, then correcting or appealing.
- Type
- Informational (supplemental)
- Usually paired with
- CO-50, CO-96
- Fixable?
- Sometimes — if diagnosis or documentation meets the LCD
- Typical fix
- Read the LCD; correct diagnosis/coding or appeal with matching documentation
What does remark code N115 mean?
Official X12 text: "This decision was based on a Local Coverage Determination (LCD). An LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy is available at the Medicare Coverage Database, or if you do not have web access, you may contact the contractor to request a copy of the LCD." In short, a MAC coverage policy drove the decision, and that policy is where the covered indications live.
ERA mini-example: 93000 (electrocardiogram) billed $30.00 denies with CO-50 and N115 because the submitted diagnosis is not on the covered-indications list in the applicable LCD. Corrected with a supported diagnosis that the documentation confirms, the ECG meets the LCD and pays.
Which denial code does N115 come with?
Most often CO-50 (not deemed a medical necessity) when the diagnosis fails the LCD, or CO-96 when the service is non-covered under the policy. The CARC states the outcome; N115 tells you an LCD is the source, so the fix starts with reading that policy. This is a medical necessity matter — decode the pairing in the denial code lookup.
How do you fix an N115 denial?
- Locate the cited LCD in the Medicare Coverage Database by the CPT/HCPCS code and your MAC jurisdiction.
- Compare your claim's diagnosis and frequency to the LCD's covered indications and limits.
- If a supported diagnosis was omitted or miscoded, submit a corrected claim with the covered ICD-10 that the record confirms.
- If the documentation already meets the LCD, appeal with the records and the specific policy criteria using the appeal letter generator.
How do you prevent N115?
Check the applicable LCD before rendering LCD-governed services and confirm the patient's diagnosis is on the covered list, capturing the supporting documentation up front. Load LCD diagnosis-to-procedure edits into your scrubber so unsupported pairings flag before submission. When a service is likely to fall outside the LCD, obtain an ABN so the balance can shift to the patient, and keep policies current since MACs revise LCDs and covered-diagnosis lists over time.
Frequently asked questions
An LCD is a coverage policy issued by a Medicare Administrative Contractor for its jurisdiction, spelling out when a specific item or service is reasonable and necessary — which diagnoses support it, how often it is covered, and what documentation is required. N115 tells you the payment decision came from an LCD, so the covered-indications and coding sections of that policy are exactly what you need to read.
Search the Medicare Coverage Database on the CMS website by the CPT/HCPCS code and your MAC jurisdiction. The LCD lists covered ICD-10 diagnoses, frequency limits, and documentation requirements. If your claim's diagnosis is not on the covered list, that is usually why it denied — and the LCD tells you exactly which diagnoses would have supported coverage.
Yes, when the documentation actually meets the LCD but the claim did not reflect it — a covered diagnosis that was not coded, or records that support necessity that were not submitted. Appeal with the specific LCD criteria matched to your documentation. If the service genuinely falls outside the LCD's covered indications, an appeal will not succeed and the denial stands.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
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