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RARC N115 · Remittance Advice Remark Code

RARC N115 Remark Code: This decision was based on a Local Coverage Determination (LCD). An LCD provide…

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Updated

Not an ICD-10 code. RARC N115 is a remittance-advice remark code published by X12 and carried on the 835 LQ segment. Any ICD-10 code with the same letters and digits (e.g., ICD-10 M15 osteoarthritis, N130 other urinary tract disorders) is a separate, unrelated code set used in diagnoses on the 837. Confirm the context before acting on this page.

TL;DR

RARC N115 (X12 This decision was based on a Local Coverage Determination (LCD). An LCD provides a guide to assist…). Commonly paired with CARC 11, CARC 50. RARC N115 tells you the denial was driven by a specific Medicare LCD (or commercial medical policy).

Official X12 description

“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.”

Source: X12 Remittance Advice Remark Codes. X12 publishes and maintains the RARC set; always verify against the current release before building a claim workflow.

Paired CARC codes

RARC N115 almost never appears alone — it accompanies one of the CARCs below on the same 835 remittance line. Fix the CARC and the RARC typically clears; the RARC alone is informational.

Paired CARCWhat the CARC means
CARC 11The diagnosis is inconsistent with the procedure.
CARC 50These are non-covered services because this is not deemed a 'medical necessity' by the payer.
CARC 167This (these) diagnosis(es) is (are) not covered.

What RARC N115 actually means

RARC N115 tells you the denial was driven by a specific Medicare LCD (or commercial medical policy). To appeal effectively, find the LCD / policy cited on the remittance (or look it up by the service on the CMS Medicare Coverage Database), read the covered-diagnosis and utilization criteria, and confirm whether the documentation satisfies them. An appeal built around the LCD's own language is far more likely to succeed than a generic 'medically necessary' argument.

Common root causes

  • Diagnosis not on the LCD's covered list.
  • Frequency limit in the LCD exceeded.
  • Documentation missing a specific element the LCD requires (e.g., prior conservative therapy).

Prevention checklist

  • LCD-aware medical-necessity scrubbing at charge entry.
  • LCD-review habit when new ICD-10 codes are introduced (January 1 and October 1 updates).

Resolution & appeal strategy — step by step

Because RARC N115 is supplemental to a CARC, the resolution path usually starts by fixing the underlying adjustment reason. A formal appeal of the RARC alone is rarely necessary.

  1. 1Pull the LCD cited on the remittance from the Medicare Coverage Database.
  2. 2Appeal with a point-by-point match between the LCD's criteria and the clinical record.
Sample reconsideration language referencing RARC N115
[Provider letterhead] Re: Reconsideration — Claim #{claim_number}, CARC 11 / RARC N115 Member: {member_name} · Member ID: {member_id} Date(s) of Service: {dos} The 835 remittance on {remittance_date} carried RARC N115: "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." We request reconsideration. The attached documentation rebuts the remark code: 1. [State the fact that rebuts the remark — authorization number, primary 835, modifier rationale, LCD citation, etc.] 2. [Reference the paired CARC and the corresponding fix] 3. [Attach the supporting document listed in step 1] Attached: {list supporting documents} Please process this line under the member's benefits. Contact the billing office at {provider_phone} for questions. Sincerely, {billing_manager_name}, {credentials}

Edit the bracketed fields before sending. Payer-specific reconsideration forms are often required — check the provider portal first.

How common is RARC N115?

Platform frequency
Pending ETL

Platform frequency ranks publish once the anonymized denial-rate pipeline reaches the publication threshold (strategy §12 Phase 2).

How QuickRCM handles RARC N115

QuickRCM reads RARC N115 alongside its paired CARC in the 835 LQ segment and routes the line to the correct worker queue with the right documentation already attached:

  • Denial routing rules tuned to the CARC+RARC pair — the paired combination tells QuickRCM which documentation the payer will accept.
  • Reconsideration template for this exact remark code pulls the supporting facts from the claim automatically.
  • Pre-submission scrubs that catch the preventable drivers surfaced on this page before the 837 leaves the clearinghouse.
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Frequently asked questions — RARC N115

What does RARC N115 mean?

RARC N115 is an X12 Remittance Advice Remark Code. The official X12 definition is: "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." It is supplemental to a Claim Adjustment Reason Code (CARC) on the same 835 line.

Which CARC is paired with RARC N115?

RARC N115 is most commonly paired with CARC 11, CARC 50, CARC 167. The CARC is the financial adjustment reason; the RARC is the informational remark. Fix the paired CARC first — the RARC usually clears with the corrected claim.

How do I resolve a RARC N115 remark on a remit?

Start from the root cause: Diagnosis not on the LCD's covered list. First step: Pull the LCD cited on the remittance from the Medicare Coverage Database. Because RARCs are supplemental, the resolution is almost always to address the paired CARC rather than appeal the RARC alone.

Where does RARC N115 appear on the 835 ERA?

RARC N115 is carried on the 835 Loop 2110 LQ segment alongside the CARC in the CAS segment of the same service line. The code and its X12 description also print on the paper EOB in the "Remark Code" or "Remark" column next to the corresponding denial or adjustment reason.

Is RARC N115 the same as ICD-10 code N115?

No. RARC N115 is a remittance-advice remark code published by X12 and carried on the 835. Any ICD-10 code with the same letters and digits is a diagnosis code on the 837 HI segment — a completely different code set maintained by the WHO/CMS. Use the transaction context (835 = RARC; 837 = ICD-10) to disambiguate.

Disclaimer

This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. X12 code descriptors are maintained by the X12 External Code Lists; always verify against the current X12 release and the payer's own published policy before submitting or appealing a claim.