Source: http://www.wpc-edi.com/reference/codelists/healthcare/remittance-advice-remark-codes/
Timestamp: 2014-04-23 15:59:09
Document Index: 555294274

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Code Lists and X12 Registry	Sign In | My Cart | Checkout
Remittance Advice Remark Codes • ASC X12 External Code Source 411LAST UPDATED 3/14/2014
Filter Alerts: Show All Show Alerts Show non-Alerts ScheduleThe Remittance Advice Remark Code List is updated tri-annually in March, July, and November.
M1X-ray not taken within the past 12 months or near enough to the start of treatment.Start: 01/01/1997
M2Not paid separately when the patient is an inpatient.Start: 01/01/1997
M3Equipment is the same or similar to equipment already being used.Start: 01/01/1997
M4Alert: This is the last monthly installment payment for this durable medical equipment.Start: 01/01/1997 | Last Modified: 04/01/2007Notes: (Modified 4/1/07)
M5Monthly 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
M6Alert: 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: 03/01/2009Notes: (Modified 4/1/07, 3/1/2009)
M7No rental payments after the item is purchased, or after the total of issued rental payments equals the purchase price.Start: 01/01/1997
M8We 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
M9Alert: 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: 04/01/2007Notes: (Modified 4/1/07)
M10Equipment purchases are limited to the first or the tenth month of medical necessity.Start: 01/01/1997
M11DME, orthotics and prosthetics must be billed to the DME carrier who services the patient's zip code.Start: 01/01/1997
M12Diagnostic tests performed by a physician must indicate whether purchased services are included on the claim.Start: 01/01/1997
M13Only one initial visit is covered per specialty per medical group.Start: 01/01/1997 | Last Modified: 06/30/2007Notes: (Modified 6/30/03)
M14No 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
M15Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.Start: 01/01/1997
M16Alert: Please see our web site, mailings, or bulletins for more details concerning this policy/procedure/decision.Start: 01/01/1997 | Last Modified: 04/01/2007Notes: (Reactivated 4/1/04, Modified 11/18/05, 4/1/07)
M17Alert: 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: 04/01/2007Notes: (Modified 4/1/07)
M18Certain 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: 06/30/2003Notes: (Modified 6/30/03)
M19Missing oxygen certification/re-certification.Start: 01/01/1997 | Last Modified: 02/28/2003Notes: (Modified 2/28/03) Related to N234
M20Missing/incomplete/invalid HCPCS.Start: 01/01/1997 | Last Modified: 02/28/2003Notes: (Modified 2/28/03)
M21Missing/incomplete/invalid place of residence for this service/item provided in a home.Start: 01/01/1997 | Last Modified: 02/28/2003Notes: (Modified 2/28/03)
M22Missing/incomplete/invalid number of miles traveled.Start: 01/01/1997 | Last Modified: 02/28/2003Notes: (Modified 2/28/03)
M23Missing invoice.Start: 01/01/1997 | Last Modified: 08/01/2005Notes: (Modified 8/1/05)
M24Missing/incomplete/invalid number of doses per vial.Start: 01/01/1997 | Last Modified: 02/28/2003Notes: (Modified 2/28/03)
M25The 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: 11/01/2010Notes: (Modified 10/1/02, 6/30/03, 8/1/05, 11/5/07, 11/1/10)
M26The 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: 11/05/2007Notes: (Modified 10/1/02, 6/30/03, 8/1/05, 11/5/07. Also refer to N356)
M27Alert: 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: 08/01/2007Notes: (Modified 10/1/02, 8/1/05, 4/1/07, 8/1/07)
M28This does not qualify for payment under Part B when Part A coverage is exhausted or not otherwise available.Start: 01/01/1997
M29Missing operative note/report.Start: 01/01/1997 | Last Modified: 07/01/2008Notes: (Modified 2/28/03, 7/1/2008) Related to N233
M30Missing pathology report.Start: 01/01/1997 | Last Modified: 08/01/2004Notes: (Modified 8/1/04, 2/28/03) Related to N236
M31Missing radiology report.Start: 01/01/1997 | Last Modified: 08/01/2004Notes: (Modified 8/1/04, 2/28/03) Related to N240
M32Alert: 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: 04/01/2007Notes: (Modified 4/1/07)
M33Missing/incomplete/invalid UPIN for the ordering/referring/performing provider.Start: 01/01/1997 | Stop: 08/01/2004Notes: Consider using M68
M34Claim lacks the CLIA certification number.Start: 01/01/1997 | Stop: 08/01/2004Notes: Consider using MA120
M35Missing/incomplete/invalid pre-operative photos or visual field results.Start: 01/01/1997 | Stop: 02/05/2005Notes: Consider using N178
M36This 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
M37Not covered when the patient is under age 35.Start: 01/01/1997 | Last Modified: 03/08/2011Notes: (Modified 3/8/11)
M38The patient is liable for the charges for this service as you informed the patient in writing before the service was furnished that we would not pay for it, and the patient agreed to pay.Start: 01/01/1997
M39The patient is not liable for payment for 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: 11/01/2012Notes: (Modified 2/1/04, 4/1/07, 11/1/09, 11/1/12) Related to N563
M40Claim must be assigned and must be filed by the practitioner's employer.Start: 01/01/1997
M41We do not pay for this as the patient has no legal obligation to pay for this.Start: 01/01/1997
M42The medical necessity form must be personally signed by the attending physician.Start: 01/01/1997
M43Payment for this service previously issued to you or another provider by another carrier/intermediary.Start: 01/01/1997 | Stop: 01/31/2004Notes: Consider using Reason Code 23
M44Missing/incomplete/invalid condition code.Start: 01/01/1997 | Last Modified: 02/28/2003Notes: (Modified 2/28/03)
M45Missing/incomplete/invalid occurrence code(s).Start: 01/01/1997 | Last Modified: 12/02/2004Notes: (Modified 12/2/04) Related to N299
M46Missing/incomplete/invalid occurrence span code(s).Start: 01/01/1997 | Last Modified: 12/02/2004Notes: (Modified 12/2/04) Related to N300
M47Missing/incomplete/invalid internal or document control number.Start: 01/01/1997 | Last Modified: 02/28/2003Notes: (Modified 2/28/03)
M48Payment 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: 01/31/2004Notes: Consider using M97
M49Missing/incomplete/invalid value code(s) or amount(s).Start: 01/01/1997 | Last Modified: 02/28/2003Notes: (Modified 2/28/03)
M50Missing/incomplete/invalid revenue code(s).Start: 01/01/1997 | Last Modified: 02/28/2003Notes: (Modified 2/28/03)
M51Missing/incomplete/invalid procedure code(s).Start: 01/01/1997 | Last Modified: 12/02/2004Notes: (Modified 12/2/04) Related to N301
M52Missing/incomplete/invalid “from” date(s) of service.Start: 01/01/1997 | Last Modified: 02/28/2003Notes: (Modified 2/28/03)
M53Missing/incomplete/invalid days or units of service.Start: 01/01/1997 | Last Modified: 02/28/2003Notes: (Modified 2/28/03)
M54Missing/incomplete/invalid total charges.Start: 01/01/1997 | Last Modified: 02/28/2003Notes: (Modified 2/28/03)
M55We do not pay for self-administered anti-emetic drugs that are not administered with a covered oral anti-cancer drug.Start: 01/01/1997
M56Missing/incomplete/invalid payer identifier.Start: 01/01/1997 | Last Modified: 02/28/2003Notes: (Modified 2/28/03)
M57Missing/incomplete/invalid provider identifier.Start: 01/01/1997 | Stop: 06/02/2005
M58Missing/incomplete/invalid claim information. Resubmit claim after corrections.Start: 01/01/1997 | Stop: 02/05/2005
M59Missing/incomplete/invalid “to” date(s) of service.Start: 01/01/1997 | Last Modified: 02/28/2003Notes: (Modified 2/28/03)
M60Missing Certificate of Medical Necessity.Start: 01/01/1997 | Last Modified: 08/01/2004Notes: (Modified 8/1/04, 6/30/03) Related to N227
M61We cannot pay for this as the approval period for the FDA clinical trial has expired.Start: 01/01/1997
M62Missing/incomplete/invalid treatment authorization code.Start: 01/01/1997 | Last Modified: 02/28/2003Notes: (Modified 2/28/03)
M63We do not pay for more than one of these on the same day.Start: 01/01/1997 | Stop: 01/31/2004Notes: Consider using M86
M64Missing/incomplete/invalid other diagnosis.Start: 01/01/1997 | Last Modified: 02/28/2003Notes: (Modified 2/28/03)
M65One 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
M66Our 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
M67Missing/incomplete/invalid other procedure code(s).Start: 01/01/1997 | Last Modified: 12/02/2004Notes: (Modified 12/2/04) Related to N302
M68Missing/incomplete/invalid attending, ordering, rendering, supervising or referring physician identification.Start: 01/01/1997 | Stop: 06/02/2005
M69Paid at the regular rate as you did not submit documentation to justify the modified procedure code.Start: 01/01/1997 | Last Modified: 02/01/2004Notes: (Modified 2/1/04)
M70Alert: 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: 08/01/2007Notes: (Modified 4/1/2007, 8/1/07)
M71Total payment reduced due to overlap of tests billed.Start: 01/01/1997
M72Did not enter full 8-digit date (MM/DD/CCYY).Start: 01/01/1997 | Stop: 10/16/2003Notes: Consider using MA52
M73The 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: 08/01/2004Notes: (Modified 8/1/04)
M74This service does not qualify for a HPSA/Physician Scarcity bonus payment.Start: 01/01/1997 | Last Modified: 12/02/2004Notes: (Modified 12/2/04)
M75Multiple automated multichannel tests performed on the same day combined for payment.Start: 01/01/1997 | Last Modified: 11/05/2007Notes: (Modified 11/5/07)
M76Missing/incomplete/invalid diagnosis or condition.Start: 01/01/1997 | Last Modified: 02/28/2003Notes: (Modified 2/28/03)
M77Missing/incomplete/invalid/inappropriate place of service.Start: 01/01/1997 | Last Modified: 03/14/2014Notes: (Modified 2/28/03, 3/1/2014, 3/14/2014)
M78Missing/incomplete/invalid HCPCS modifier.Start: 01/01/1997 | Stop: 05/18/2006 | Last Modified: 02/28/2003Notes: (Modified 2/28/03,) Consider using Reason Code 4
M79Missing/incomplete/invalid charge.Start: 01/01/1997 | Last Modified: 02/28/2003Notes: (Modified 2/28/03)
M80Not covered when performed during the same session/date as a previously processed service for the patient.Start: 01/01/1997 | Last Modified: 10/31/2002Notes: (Modified 10/31/02)
M81You are required to code to the highest level of specificity.Start: 01/01/1997 | Last Modified: 02/01/2004Notes: (Modified 2/1/04)
M82Service is not covered when patient is under age 50.Start: 01/01/1997
M83Service is not covered unless the patient is classified as at high risk.Start: 01/01/1997
M84Medical code sets used must be the codes in effect at the time of service.Start: 01/01/1997 | Last Modified: 03/14/2014Notes: (Modified 2/1/04, 3/14/2014)
M85Subjected to review of physician evaluation and management services.Start: 01/01/1997
M86Service denied because payment already made for same/similar procedure within set time frame.Start: 01/01/1997 | Last Modified: 06/30/2003Notes: (Modified 6/30/03)
M87Claim/service(s) subjected to CFO-CAP prepayment review.Start: 01/01/1997
M88We cannot pay for laboratory tests unless billed by the laboratory that did the work.Start: 01/01/1997 | Stop: 08/01/2004Notes: Consider using Reason Code B20
M89Not covered more than once under age 40.Start: 01/01/1997
M90Not covered more than once in a 12 month period.Start: 01/01/1997
M91Lab procedures with different C