N54
Claim information is inconsistent with pre-certified/authorized services
What This Code Means
What was billed doesn’t match what was actually pre-certified or authorized.
Common Causes
- Different CPT code billed than what was authorized
- Date of service billed falls outside the authorized date range
How to Resolve or Appeal
- Compare the authorization details exactly against what was billed
- Correct and resubmit if it was a data mismatch, or appeal with an authorization amendment
More Denial Codes to Check
Educational reference only — not medical or legal advice. Always confirm code usage and appeal rights with the specific payer.