Remark Code or Remittance Advice Code M-list

Remittance Advice Remark Code List

M1 X-ray not taken within the past 12 months or near enough to the start of treatment.
Start: 01/01/1997
M2 Not paid separately when the patient is an inpatient.
Start: 01/01/1997
M3 Equipment is the same or similar to equipment already being used.
Start: 01/01/1997
M4 Alert: This is the last monthly installment payment for this durable medical equipment.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
M5 Monthly rental payments can continue until the earlier of the 15th month from the first rental month, or the month when the equipment is no longer needed.
Start: 01/01/1997
M6 Alert: You must furnish and service this item for any period of medical need for the remainder of the reasonable useful lifetime of the equipment.
Start: 01/01/1997 | Last Modified: 03/01/2009
Notes: (Modified 4/1/07, 3/1/2009)
M7 No rental payments after the item is purchased, returned or after the total of issued rental payments equals the purchase price.
Start: 01/01/1997 | Last Modified: 11/01/2016
Notes: (Modified 11/1/2016)
M8 We do not accept blood gas tests results when the test was conducted by a medical supplier or taken while the patient is on oxygen.
Start: 01/01/1997
M9 Alert: This is the tenth rental month. You must offer the patient the choice of changing the rental to a purchase agreement.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
M10 Equipment purchases are limited to the first or the tenth month of medical necessity.
Start: 01/01/1997
M11 DME, orthotics and prosthetics must be billed to the DME carrier who services the patient's zip code.
Start: 01/01/1997
M12 Diagnostic tests performed by a physician must indicate whether purchased services are included on the claim.
Start: 01/01/1997
M13 Only one initial visit is covered per specialty per medical group.
Start: 01/01/1997 | Last Modified: 06/30/2007
Notes: (Modified 6/30/03)
M14 No separate payment for an injection administered during an office visit, and no payment for a full office visit if the patient only received an injection.
Start: 01/01/1997
M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
Start: 01/01/1997
M16 Alert: Please see our web site, mailings, or bulletins for more details concerning this policy/procedure/decision.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Reactivated 4/1/04, Modified 11/18/05, 4/1/07)
M17 Alert: Payment approved as you did not know, and could not reasonably have been expected to know, that this would not normally have been covered for this patient. In the future, you will be liable for charges for the same service(s) under the same or similar conditions.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
M18 Certain services may be approved for home use. Neither a hospital nor a Skilled Nursing Facility (SNF) is considered to be a patient's home.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
M19 Missing oxygen certification/re-certification.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N234
M20 Missing/incomplete/invalid HCPCS.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M21 Missing/incomplete/invalid place of residence for this service/item provided in a home.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M22 Missing/incomplete/invalid number of miles traveled.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M23 Missing invoice.
Start: 01/01/1997 | Last Modified: 08/01/2005
Notes: (Modified 8/1/05)
M24 Missing/incomplete/invalid number of doses per vial.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M25 The information furnished does not substantiate the need for this level of service. If you believe the service should have been fully covered as billed, or if you did not know and could not reasonably have been expected to know that we would not pay for this level of service, or if you notified the patient in writing in advance that we would not pay for this level of service and he/she agreed in writing to pay, ask us to review your claim within 120 days of the date of this notice. If you do not request an appeal, we will, upon application from the patient, reimburse him/her for the amount you have collected from him/her in excess of any deductible and coinsurance amounts. We will recover the reimbursement from you as an overpayment.
Start: 01/01/1997 | Last Modified: 11/01/2010
Notes: (Modified 10/1/02, 6/30/03, 8/1/05, 11/5/07, 11/1/10)
M26 The information furnished does not substantiate the need for this level of service. If you have collected any amount from the patient for this level of service/any amount that exceeds the limiting charge for the less extensive service, the law requires you to refund that amount to the patient within 30 days of receiving this notice.
The requirements for refund are in 1824(I) of the Social Security Act and 42CFR411.408. The section specifies that physicians who knowingly and willfully fail to make appropriate refunds may be subject to civil monetary penalties and/or exclusion from the program. If you have any questions about this notice, please contact this office.
Start: 01/01/1997 | Last Modified: 11/05/2007
Notes: (Modified 10/1/02, 6/30/03, 8/1/05, 11/5/07. Also refer to N356)
M27 Alert: The patient has been relieved of liability of payment of these items and services under the limitation of liability provision of the law. The provider is ultimately liable for the patient's waived charges, including any charges for coinsurance, since the items or services were not reasonable and necessary or constituted custodial care, and you knew or could reasonably have been expected to know, that they were not covered. You may appeal this determination. You may ask for an appeal regarding both the coverage determination and the issue of whether you exercised due care. The appeal request must be filed within 120 days of the date you receive this notice. You must make the request through this office.
Start: 01/01/1997 | Last Modified: 08/01/2007
Notes: (Modified 10/1/02, 8/1/05, 4/1/07, 8/1/07)
M28 This does not qualify for payment under Part B when Part A coverage is exhausted or not otherwise available.
Start: 01/01/1997
M29 Missing operative note/report.
Start: 01/01/1997 | Last Modified: 07/01/2008
Notes: (Modified 2/28/03, 7/1/2008) Related to N233
M30 Missing pathology report.
Start: 01/01/1997 | Last Modified: 08/01/2004
Notes: (Modified 8/1/04, 2/28/03) Related to N236
M31 Missing radiology report.
Start: 01/01/1997 | Last Modified: 08/01/2004
Notes: (Modified 8/1/04, 2/28/03) Related to N240
M32 Alert: This is a conditional payment made pending a decision on this service by the patient's primary payer. This payment may be subject to refund upon your receipt of any additional payment for this service from another payer. You must contact this office immediately upon receipt of an additional payment for this service.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
M33 Missing/incomplete/invalid UPIN for the ordering/referring/performing provider.
Start: 01/01/1997 | Stop: 08/01/2004
Notes: Consider using M68
M34 Claim lacks the CLIA certification number.
Start: 01/01/1997 | Stop: 08/01/2004
Notes: Consider using MA120
M35 Missing/incomplete/invalid pre-operative photos or visual field results.
Start: 01/01/1997 | Stop: 02/05/2005
Notes: Consider using N178
M36 This is the 11th rental month. We cannot pay for this until you indicate that the patient has been given the option of changing the rental to a purchase.
Start: 01/01/1997
M37 Not covered when the patient is under age 35.
Start: 01/01/1997 | Last Modified: 03/08/2011
Notes: (Modified 3/8/11)
M38 Alert: The patient is liable for the charges for this service as they were informed in writing before the service was furnished that we would not pay for it and the patient agreed to be responsible for the charges.
Start: 01/01/1997 | Last Modified: 07/01/2015
Notes: (Modified 7/1/15)
M39 Alert: The patient is not liable for payment of this service as the advance notice of non-coverage you provided the patient did not comply with program requirements.
Start: 01/01/1997 | Last Modified: 07/01/2015
Notes: (Modified 2/1/04, 4/1/07, 11/1/09, 11/1/12, 7/1/15) Related to N563
M40 Claim must be assigned and must be filed by the practitioner's employer.
Start: 01/01/1997
M41 We do not pay for this as the patient has no legal obligation to pay for this.
Start: 01/01/1997
M42 The medical necessity form must be personally signed by the attending physician.
Start: 01/01/1997
M43 Payment for this service previously issued to you or another provider by another carrier/intermediary.
Start: 01/01/1997 | Stop: 01/31/2004
Notes: Consider using Reason Code 23
M44 Missing/incomplete/invalid condition code.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M45 Missing/incomplete/invalid occurrence code(s).
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04) Related to N299
M46 Missing/incomplete/invalid occurrence span code(s).
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04) Related to N300
M47 Missing/incomplete/invalid Payer Claim Control Number. Other terms exist for this element including, but not limited to, Internal Control Number (ICN), Claim Control Number (CCN), Document Control Number (DCN).
Start: 01/01/1997 | Last Modified: 07/01/2015
Notes: (Modified 2/28/03, 7/1/15)
M48 Payment for services furnished to hospital inpatients (other than professional services of physicians) can only be made to the hospital. You must request payment from the hospital rather than the patient for this service.
Start: 01/01/1997 | Stop: 01/31/2004
Notes: Consider using M97
M49 Missing/incomplete/invalid value code(s) or amount(s).
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M50 Missing/incomplete/invalid revenue code(s).
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M51 Missing/incomplete/invalid procedure code(s).
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04) Related to N301
M52 Missing/incomplete/invalid “from” date(s) of service.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M53 Missing/incomplete/invalid days or units of service.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M54 Missing/incomplete/invalid total charges.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M55 We do not pay for self-administered anti-emetic drugs that are not administered with a covered oral anti-cancer drug.
Start: 01/01/1997
M56 Missing/incomplete/invalid payer identifier.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M57 Missing/incomplete/invalid provider identifier.
Start: 01/01/1997 | Stop: 06/02/2005
M58 Missing/incomplete/invalid claim information. Resubmit claim after corrections.
Start: 01/01/1997 | Stop: 02/05/2005
M59 Missing/incomplete/invalid “to” date(s) of service.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M60 Missing Certificate of Medical Necessity.
Start: 01/01/1997 | Last Modified: 08/01/2004
Notes: (Modified 8/1/04, 6/30/03) Related to N227
M61 We cannot pay for this as the approval period for the FDA clinical trial has expired.
Start: 01/01/1997
M62 Missing/incomplete/invalid treatment authorization code.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M63 We do not pay for more than one of these on the same day.
Start: 01/01/1997 | Stop: 01/31/2004
Notes: Consider using M86
M64 Missing/incomplete/invalid other diagnosis.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M65 One interpreting physician charge can be submitted per claim when a purchased diagnostic test is indicated. Please submit a separate claim for each interpreting physician.
Start: 01/01/1997
M66 Our records indicate that you billed diagnostic tests subject to price limitations and the procedure code submitted includes a professional component. Only the technical component is subject to price limitations. Please submit the technical and professional components of this service as separate line items.
Start: 01/01/1997
M67 Missing/incomplete/invalid other procedure code(s).
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04) Related to N302
M68 Missing/incomplete/invalid attending, ordering, rendering, supervising or referring physician identification.
Start: 01/01/1997 | Stop: 06/02/2005
M69 Paid at the regular rate as you did not submit documentation to justify the modified procedure code.
Start: 01/01/1997 | Last Modified: 02/01/2004
Notes: (Modified 2/1/04)
M70 Alert: The NDC code submitted for this service was translated to a HCPCS code for processing, but please continue to submit the NDC on future claims for this item.
Start: 01/01/1997 | Last Modified: 08/01/2007
Notes: (Modified 4/1/2007, 8/1/07)
M71 Total payment reduced due to overlap of tests billed.
Start: 01/01/1997
M72 Did not enter full 8-digit date (MM/DD/CCYY).
Start: 01/01/1997 | Stop: 10/16/2003
Notes: Consider using MA52
M73 The HPSA/Physician Scarcity bonus can only be paid on the professional component of this service. Rebill as separate professional and technical components.
Start: 01/01/1997 | Last Modified: 08/01/2004
Notes: (Modified 8/1/04)
M74 This service does not qualify for a HPSA/Physician Scarcity bonus payment.
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04)
M75 Multiple automated multichannel tests performed on the same day combined for payment.
Start: 01/01/1997 | Last Modified: 11/05/2007
Notes: (Modified 11/5/07)
M76 Missing/incomplete/invalid diagnosis or condition.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M77 Missing/incomplete/invalid/inappropriate place of service.
Start: 01/01/1997 | Last Modified: 03/14/2014
Notes: (Modified 2/28/03, 3/1/2014, 3/14/2014)
M78 Missing/incomplete/invalid HCPCS modifier.
Start: 01/01/1997 | Stop: 05/18/2006 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03,) Consider using Reason Code 4
M79 Missing/incomplete/invalid charge.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M80 Not covered when performed during the same session/date as a previously processed service for the patient.
Start: 01/01/1997 | Last Modified: 10/31/2002
Notes: (Modified 10/31/02)
M81 You are required to code to the highest level of specificity.
Start: 01/01/1997 | Last Modified: 02/01/2004
Notes: (Modified 2/1/04)
M82 Service is not covered when patient is under age 50.
Start: 01/01/1997
M83 Service is not covered unless the patient is classified as at high risk.
Start: 01/01/1997
M84 Medical code sets used must be the codes in effect at the time of service.
Start: 01/01/1997 | Last Modified: 03/14/2014
Notes: (Modified 2/1/04, 3/14/2014)
M85 Subjected to review of physician evaluation and management services.
Start: 01/01/1997
M86 Service denied because payment already made for same/similar procedure within set time frame.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
M87 Claim/service(s) subjected to CFO-CAP prepayment review.
Start: 01/01/1997
M88 We cannot pay for laboratory tests unless billed by the laboratory that did the work.
Start: 01/01/1997 | Stop: 08/01/2004
Notes: Consider using Reason Code B20
M89 Not covered more than once under age 40.
Start: 01/01/1997
M90 Not covered more than once in a 12 month period.
Start: 01/01/1997
M91 Lab procedures with different CLIA certification numbers must be billed on separate claims.
Start: 01/01/1997
M92 Services subjected to review under the Home Health Medical Review Initiative.
Start: 01/01/1997 | Stop: 08/01/2004
M93 Information supplied supports a break in therapy. A new capped rental period began with delivery of this equipment.
Start: 01/01/1997
M94 Information supplied does not support a break in therapy. A new capped rental period will not begin.
Start: 01/01/1997
M95 Services subjected to Home Health Initiative medical review/cost report audit.
Start: 01/01/1997
M96 The technical component of a service furnished to an inpatient may only be billed by that inpatient facility. You must contact the inpatient facility for technical component reimbursement. If not already billed, you should bill us for the professional component only.
Start: 01/01/1997
M97 Not paid to practitioner when provided to patient in this place of service. Payment included in the reimbursement issued the facility.
Start: 01/01/1997
M98 Begin to report the Universal Product Number on claims for items of this type. We will soon begin to deny payment for items of this type if billed without the correct UPN.
Start: 01/01/1997 | Stop: 01/31/2004
Notes: Consider using M99
M99 Missing/incomplete/invalid Universal Product Number/Serial Number.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M100 We do not pay for an oral anti-emetic drug that is not administered for use immediately before, at, or within 48 hours of administration of a covered chemotherapy drug.
Start: 01/01/1997
M101 Begin to report a G1-G5 modifier with this HCPCS. We will soon begin to deny payment for this service if billed without a G1-G5 modifier.
Start: 01/01/1997 | Stop: 01/31/2004
Notes: Consider using M78
M102 Service not performed on equipment approved by the FDA for this purpose.
Start: 01/01/1997
M103 Information supplied supports a break in therapy. However, the medical information we have for this patient does not support the need for this item as billed. We have approved payment for this item at a reduced level, and a new capped rental period will begin with the delivery of this equipment.
Start: 01/01/1997
M104 Information supplied supports a break in therapy. A new capped rental period will begin with delivery of the equipment. This is the maximum approved under the fee schedule for this item or service.
Start: 01/01/1997
M105 Information supplied does not support a break in therapy. The medical information we have for this patient does not support the need for this item as billed. We have approved payment for this item at a reduced level, and a new capped rental period will not begin.
Start: 01/01/1997
M106 Information supplied does not support a break in therapy. A new capped rental period will not begin. This is the maximum approved under the fee schedule for this item or service.
Start: 01/01/1997 | Stop: 01/31/2004
Notes: Consider using MA 31
M107 Payment reduced as 90-day rolling average hematocrit for ESRD patient exceeded 36.5%.
Start: 01/01/1997
M108 Missing/incomplete/invalid provider identifier for the provider who interpreted the diagnostic test.
Start: 01/01/1997 | Stop: 06/02/2005
M109 We have provided you with a bundled payment for a teleconsultation. You must send 25 percent of the teleconsultation payment to the referring practitioner.
Start: 01/01/1997
M110 Missing/incomplete/invalid provider identifier for the provider from whom you purchased interpretation services.
Start: 01/01/1997 | Stop: 06/02/2005
M111 We do not pay for chiropractic manipulative treatment when the patient refuses to have an x-ray taken.
Start: 01/01/1997
M112 Reimbursement for this item is based on the single payment amount required under the DMEPOS Competitive Bidding Program for the area where the patient resides.
Start: 01/01/1997 | Last Modified: 11/05/2007
Notes: (Modified 11/5/07)
M113 Our records indicate that this patient began using this item/service prior to the current contract period for the DMEPOS Competitive Bidding Program.
Start: 01/01/1997 | Last Modified: 11/05/2007
Notes: (Modified 11/5/07)
M114 This service was processed in accordance with rules and guidelines under the DMEPOS Competitive Bidding Program or a Demonstration Project. For more information regarding these projects, contact your local contractor.
Start: 01/01/1997 | Last Modified: 11/05/2007
Notes: (Modified 8/1/06, 11/5/07)
M115 This item is denied when provided to this patient by a non-contract or non-demonstration supplier.
Start: 01/01/1997 | Last Modified: 11/05/2007
Notes: (Modified 11/5/2007)
M116 Processed under a demonstration project or program. Project or program is ending and additional services may not be paid under this project or program.
Start: 01/01/1997 | Last Modified: 03/08/2011
Notes: (Modified 2/1/04, 3/15/11)
M117 Not covered unless submitted via electronic claim.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
M118 Letter to follow containing further information.
Start: 01/01/1997 | Stop: 01/01/2011 | Last Modified: 11/01/2009
Notes: Consider using N202
M119 Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 2/28/03, 4/1/04)
M120 Missing/incomplete/invalid provider identifier for the substituting physician who furnished the service(s) under a reciprocal billing or locum tenens arrangement.
Start: 01/01/1997 | Stop: 06/02/2005
M121 We pay for this service only when performed with a covered cryosurgical ablation.
Start: 01/01/1997
M122 Missing/incomplete/invalid level of subluxation.
Start: 01/01/1997 | Last Modified: 02/28/2006
Notes: (Modified 2/28/03)
M123 Missing/incomplete/invalid name, strength, or dosage of the drug furnished.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M124 Missing indication of whether the patient owns the equipment that requires the part or supply.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N230
M125 Missing/incomplete/invalid information on the period of time for which the service/supply/equipment will be needed.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M126 Missing/incomplete/invalid individual lab codes included in the test.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M127 Missing patient medical record for this service.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N237
M128 Missing/incomplete/invalid date of the patient’s last physician visit.
Start: 01/01/1997 | Stop: 06/02/2005
M129 Missing/incomplete/invalid indicator of x-ray availability for review.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 2/28/03, 6/30/03)
M130 Missing invoice or statement certifying the actual cost of the lens, less discounts, and/or the type of intraocular lens used.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N231
M131 Missing physician financial relationship form.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N239
M132 Missing pacemaker registration form.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N235
M133 Claim did not identify who performed the purchased diagnostic test or the amount you were charged for the test.
Start: 01/01/1997
M134 Performed by a facility/supplier in which the provider has a financial interest.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
M135 Missing/incomplete/invalid plan of treatment.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M136 Missing/incomplete/invalid indication that the service was supervised or evaluated by a physician.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M137 Part B coinsurance under a demonstration project or pilot program.
Start: 01/01/1997 | Last Modified: 11/01/2012
Notes: (Modified 11/1/12)
M138 Patient identified as a demonstration participant but the patient was not enrolled in the demonstration at the time services were rendered. Coverage is limited to demonstration participants.
Start: 01/01/1997
M139 Denied services exceed the coverage limit for the demonstration.
Start: 01/01/1997
M140 Service not covered until after the patient’s 50th birthday, i.e., no coverage prior to the day after the 50th birthday
Start: 01/01/1997 | Stop: 01/30/2004
Notes: Consider using M82
M141 Missing physician certified plan of care.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N238
M142 Missing American Diabetes Association Certificate of Recognition.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N226
M143 The provider must update license information with the payer.
Start: 01/01/1997 | Last Modified: 12/01/2006
Notes: (Modified 12/1/06)
M144 Pre-/post-operative care payment is included in the allowance for the surgery/procedure.
Start: 01/01/1997