Reason Code 5D011: Agree with Provider (Provider Liable)

Published 05/22/2019

Reason code 5D011 means that documentation supports the service provided was not covered; however, the Advanced Beneficiary Notice (ABN) of Non-coverage was invalid, and therefore, the provider is liable for charges incurred on this bill.

To Prevent This Denial

  • The provider should always verify covered services
  • The provider should verify that the Advanced Beneficiary Notice (ABN) is valid that is provided to the beneficiary

For more information refer to CMS Internet Only Manuals (IOMs), Medicare Claims Processing Manual Publication 100-04, Chapter 30, Section 50.6.1 (PDF, 1.011 KB).