RARC N386 Active Supplemental

RARC N386: Decision Based on National Coverage Determination

What This Means

The claim decision was based on a National Coverage Determination (NCD), which defines whether Medicare covers a specific item or service nationally. The billed procedure may not align with the coverage criteria established in the applicable NCD. Review the relevant NCD policy at cms.gov, verify that the diagnosis and procedure codes meet the coverage requirements, and resubmit with corrected codes or supporting documentation if appropriate.

Disclaimer
This content is for informational purposes only. Always verify against your payer contracts and current coding guidelines.

Commonly Paired With

RARC N386 commonly appears alongside these CARC denial codes:

Code Name
CO-39 Services Denied at Pre-Certification →
CO-40 Charges Not Qualifying as Emergent/Urgent Care →
CO-49 Routine/Preventive Exam Not Covered (also PR-49, OA-49) →
CO-50 Non-Covered Services / Medical Necessity Denial (also PR-50) →
CO-56 Procedure / Treatment Not Deemed Effective →
CO-78 Non-Covered Days / Room Charge Adjustment (also PR-78, OA-78) →
CO-95 Plan Procedures Not Followed (also PR-95, OA-95) →
CO-108 Rent/Purchase Guidelines Not Met →
CO-114 Procedure/Product Not FDA Approved →
CO-146 Diagnosis Code Invalid for Date of Service →
PR-149 Lifetime Benefit Maximum Reached →
CO-150 Documentation Does Not Support Level of Service →
CO-151 Documentation Does Not Support Service Frequency →
CO-152 Documentation Does Not Support Length of Service →
CO-153 Documentation Does Not Support Prescribed Dosage →
CO-154 Documentation Does Not Support Day's Supply of Medication/Supplies →
CO-158 Service Provided Outside the United States →
CO-167 Diagnosis Not Covered (also PR-167, OA-167) →
CO-169 Alternate Benefit Provided (also PR-169, OA-169) →
CO-177 Patient Eligibility Requirements Not Met (also PR-177, OA-177) →
CO-179 Waiting Requirements Not Met (also PR-179) →
CO-180 Residency Requirements Not Met (also PR-180) →
CO-186 Level of Care Change Adjustment →
CO-188 Product/Procedure Not Covered Unless FDA-Recommended →
CO-190 Payment Included in SNF Qualified Stay Allowance →
CO-197 Precertification/Authorization/Notification Absent →
CO-198 Precertification/Authorization Limits Exceeded →
PR-204 Service/Equipment/Drug Not Covered Under Benefit Plan →
CO-210 Pre-Certification/Authorization Not Timely →
CO-216 Review Organization Findings (also OA-216, PR-216) →
CO-256 Service Not Payable Per Managed Care Contract →
CO-302 Authorization Time Limit Expired (also OA-302) →
CO-A1 Missing Remark Code (also OA-A1) →
CO-A6 Prior Hospitalization or 30-Day Transfer Requirement Not Met (also OA-A6) →
CO-B1 Non-Covered Visits (also PR-B1, OA-B1) →
CO-B22 Payment Adjusted Based on Diagnosis (also PR-B22, OA-B22) →
CO-B4 Late Filing Penalty (also OA-B4) →
CO-B8 Alternative Services Not Utilized (also OA-B8) →

Sources

  1. X12.org