Reason Code 5D169: Services Not Documented

Published 05/22/2019

Reason for Denial
This claim was partially or fully denied because the provider billed for services/items not documented in the medical record submitted.

To Prevent This Denial

  • Submit all documentation related to the services billed
  • Ensure that results submitted are for the date of service billed, the correct beneficiary and the specific service billed

For more information refer to CMS Internet Only Manual (IOM) Medicare Program Integrity Manual Chapter 3, Section (PDF).

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