RARC N386: Decision Based on National Coverage Determination
The claim decision was based on a Medicare National Coverage Determination — review the specific NCD to understand the coverage criteria and determine whether the service qualifies or an appeal is warranted.
What Does RARC N386 Mean?
RARC N386 indicates that a National Coverage Determination (NCD) was the policy basis for the payer's decision on this claim. NCDs are CMS-issued policies that apply uniformly across all Medicare Administrative Contractors, establishing whether Medicare covers a particular item or service and under what clinical circumstances. When N386 appears on a remittance, the NCD was the determining factor in how the claim was adjudicated.
N386 functions similarly to N115, as both reference NCD-based decisions. The presence of one versus the other may depend on the payer's system configuration or the specific context of the adjudication. Regardless of which code appears, the resolution approach is the same: identify the applicable NCD and evaluate whether the billed service meets its coverage criteria.
NCDs cover a wide range of services, from screening tests and diagnostic procedures to devices and treatments. Each NCD specifies the conditions under which coverage applies — including required diagnoses, patient eligibility criteria, provider qualifications, and any frequency or setting limitations. A claim can be denied, partially paid, or paid in full based on how well it aligns with the NCD requirements.
What to Do
Identify the specific NCD that applies to the service billed. Search the CMS Medicare Coverage Database (cms.gov/medicare-coverage-database) by procedure code or service name. Once you locate the NCD, review all coverage criteria — covered indications, required diagnoses, patient conditions, frequency limits, and any provider or setting requirements.
If the claim was denied and you believe the service meets the NCD criteria, file an appeal with detailed documentation addressing each coverage requirement. Reference the NCD number in your appeal and include clinical notes, lab results, or other evidence showing the patient qualifies. If the service does not meet the NCD criteria, check whether an Advance Beneficiary Notice (ABN) was signed before the service was rendered, which would allow you to bill the patient directly.
Common Scenarios
- A claim for a genetic test is denied because the NCD limits coverage to patients with specific clinical indications that were not documented on the claim
- A prosthetic device claim is partially denied because the NCD covers the basic model but not the upgraded version that was billed
- A treatment is denied because the NCD requires that less invasive alternatives be tried first, and the documentation does not show prior treatment attempts
- A preventive service is denied based on the NCD's age or risk-factor requirements that the patient does not meet according to the submitted diagnosis codes
Commonly Paired With
RARC N386 commonly appears alongside these CARC denial codes: