Denial code M54

Remark code M1 indicates a claim denial because an X-ray wasn't taken within 12 months or close to treatment start.

Remark code M10 indicates coverage for equipment purchases is restricted to the initial or tenth month of medical need.

Remark code M100 indicates a denial for oral anti-emetic drugs not used within 48 hours of chemotherapy.

Remark code M102 indicates a service was denied because it wasn't performed on FDA-approved equipment for the intended use.

Remark code M103 indicates a therapy break is supported by info provided, but the medical need for the billed item isn't, leading to reduced payment.

Remark code M104 indicates a break in therapy is confirmed, starting a new rental period for equipment and noting the fee schedule's maximum approval.

Remark code M105 indicates a break in therapy is unsupported by provided info, resulting in reduced payment approval and no new rental period start.

Remark code M107 indicates a payment reduction due to an ESRD patient's 90-day average hematocrit level exceeding 36.5%.

Remark code M109 indicates a bundled teleconsultation payment, with instructions to send 25% to the referring practitioner.

Remark code M11 indicates that billing for DME, orthotics, and prosthetics should be directed to the DME carrier for the patient's zip code.

Remark code M111 indicates denial of chiropractic treatment coverage if the patient declines an x-ray.

Remark code M112 indicates reimbursement is based on the DMEPOS Competitive Bidding Program's single payment amount for the patient's area.

Remark code M113 indicates a patient started using DMEPOS before the current Competitive Bidding Program contract period.

Remark code M114 indicates a service was aligned with DMEPOS Competitive Bidding rules. Contact your contractor for project details.

Remark code M115 indicates denial of an item when supplied to a patient by a non-contract or non-demo provider.

Remark code M116 indicates a claim was processed under a demo project or program that's ending, affecting future service payments.

Remark code M117 indicates a service is not covered unless the claim is submitted electronically to the insurer.

Remark code M119 indicates a claim issue due to a missing, incomplete, invalid, or inactive National Drug Code.

Remark code M12 indicates if diagnostic tests by a physician include purchased services on the claim, impacting reimbursement.

Remark code M121 indicates payment for a service is approved only if performed alongside a covered cryosurgical ablation.

Remark code M122 indicates a claim rejection due to missing, incomplete, or invalid subluxation level documentation.

Remark code M123 indicates a claim issue due to missing or incorrect drug name, strength, or dosage details.

Remark code M124 indicates a missing declaration on whether the patient owns the equipment needing the part or supply.

Remark code M125 indicates a claim was denied due to missing or invalid details about the service duration needed.

Remark code M126 indicates missing, incomplete, or invalid lab codes within a bundled lab test claim.

Remark code M127 indicates a claim denial due to the absence of the patient's medical record for the billed service.

Remark code M129 indicates an error due to missing or invalid x-ray availability indicators for review in claims.

Remark code M13 indicates that for each specialty within a medical group, only one initial visit is reimbursed.

Remark code M130 indicates a claim denial due to missing invoice or certification of lens cost and type for intraocular lens procedures.

Remark code M131 indicates a claim denial due to the absence of the required physician financial relationship form.

Remark code M132 indicates a claim denial due to a missing pacemaker registration form required for processing.

Remark code M133 indicates a claim was rejected for not specifying the provider or cost of a purchased diagnostic test.

Remark code M134 indicates a service was provided by a facility with financial ties to the referring provider.

Remark code M135 indicates a claim issue due to a missing, incomplete, or invalid plan of treatment.

Remark code M136 indicates a claim error due to missing or invalid proof of physician supervision or evaluation of the service.

Remark code M137 indicates a Part B coinsurance adjustment under a demo project or pilot program for healthcare providers.

Remark code M138 indicates services were rendered to a non-enrolled patient in a demo, limiting coverage to actual participants.

Remark code M139 indicates a denial because services surpassed the coverage limit for the specific demonstration project.

Remark code M14 indicates no separate payment for injections during an office visit or for visits with injections only.

Remark code M141 indicates a claim was denied due to a missing physician-certified plan of care.

Remark code M142 indicates a claim was denied due to a missing American Diabetes Association Certificate of Recognition.

Remark code M143 indicates that the provider needs to update their license information with the insurance payer for claims processing.

Remark code M144 indicates that payment for pre/post-operative care is bundled into the surgery/procedure fee and not paid separately.

Remark code M15 indicates that billed services/tests are bundled together, as they're part of one procedure, disallowing separate payments.

Remark code M16 indicates a request to check the insurer's website or bulletins for details on specific policies or decisions.

Remark code M17 indicates payment is approved due to provider's lack of knowledge about non-coverage, with future liability for similar services.

Remark code M18 indicates if services are approved for home use, specifying that hospitals and SNFs are not classified as homes.

Remark code M19 indicates a claim denial due to missing oxygen certification or re-certification documentation.

Remark code M2 indicates that the service is not billed separately when the patient is hospitalized.

Remark code M20 indicates a claim issue due to missing, incomplete, or invalid HCPCS codes, requiring correction for payment.

Remark code M21 indicates a claim issue due to missing or invalid residence details for home-based services or items.

Remark code M22 indicates a claim issue due to missing, incomplete, or invalid mileage details.

Remark code M23 indicates that a claim has been processed but lacks the required invoice documentation.

Remark code M24 indicates a claim issue due to missing, incomplete, or invalid data on the number of doses per vial.

Remark code M25 indicates that the service level billed lacks necessary documentation for coverage. Appeal within 120 days if justified.

Remark code M26 indicates that the service level billed isn't justified by provided info, and excess patient charges must be refunded within 30 days.

Remark code M27 indicates the provider is liable for charges waived due to services not being necessary or custodial care, with appeal rights.

Remark code M28 indicates a service isn't eligible for Part B payment when Part A is exhausted or unavailable.

Remark code M29 indicates a claim denial due to the absence of the required operative note/report for processing.

Remark code M3 indicates that the claim involves equipment similar to what the patient is already using, impacting coverage.

Remark code M30 indicates a claim denial due to a missing pathology report, prompting action to resolve the issue.

Remark code M31 indicates a claim denial due to a missing radiology report, prompting action to provide the necessary documentation.

Remark code M32 indicates a conditional payment made while awaiting the primary payer's decision, which may require a refund if further payment is received.

Remark code M36 indicates the 11th rental month payment is pending until confirmation of the patient's purchase option is provided.

Remark code M37 indicates a service isn't covered if the patient is under 35 years old.

Remark code M38 indicates the patient agreed in writing to pay for services not covered by insurance prior to receiving them.

Remark code M39 indicates the patient isn't responsible for payment due to non-compliance with advance notice of non-coverage rules.

Remark code M4 indicates the final monthly payment for durable medical equipment has been processed.

Remark code M40 indicates that a claim must be assigned and filed by the practitioner's employer for processing.

Remark code M41 indicates a denial of payment because the patient is not legally required to pay for the service billed.

Remark code M42 indicates that the attending physician must personally sign the medical necessity form for compliance.

Remark code M44 indicates a claim issue due to missing, incomplete, or invalid condition codes, requiring review for correction.

Remark code M45 indicates a claim has been rejected due to missing, incomplete, or invalid occurrence codes.

Remark code M46 indicates a claim issue due to missing, incomplete, or invalid occurrence span codes, requiring correction.

Remark code M47 indicates a claim was rejected due to a missing or invalid Payer Claim Control Number, also known as ICN, CCN, or DCN.

Remark code M49 indicates a claim issue due to missing, incomplete, or invalid value codes or amounts, requiring correction.

Remark code M5 indicates rental payments for equipment may persist up to the 15th month or until it's no longer required.

Remark code M50 indicates a claim issue due to missing, incomplete, or invalid revenue codes, requiring correction for payment.

Remark code M51 indicates a claim issue due to missing, incomplete, or invalid procedure codes, requiring correction.

Remark code M52 indicates a claim was denied due to missing or incorrect 'from' service dates, requiring correction for processing.

Remark code M53 indicates an error due to missing, incomplete, or invalid days or units of service on a claim.

Remark code M55 indicates a denial for self-administered anti-emetic drugs without a covered oral anti-cancer drug.

Remark code M56 indicates an issue with the payer identifier, such as it being missing, incomplete, or invalid in a claim.

Remark code M59 indicates an error due to missing, incomplete, or invalid 'to' dates of service on a healthcare claim.

Remark code M6 indicates that providers must supply and maintain equipment for its entire reasonable lifetime as needed for patient care.

Remark code M60 indicates a claim rejection due to a missing Certificate of Medical Necessity form.

Remark code M61 indicates a claim denial because the FDA clinical trial approval period has lapsed, preventing payment.

Remark code M62 indicates a claim issue due to a missing, incomplete, or invalid treatment authorization code.

Remark code M64 indicates a claim issue due to a missing, incomplete, or invalid secondary diagnosis.

Remark code M65 indicates only one interpreting physician charge per claim is allowed for purchased diagnostic tests; separate claims are needed for each physician.

Remark code M66 indicates billing errors for tests with price limits; it advises separating technical and professional components on claims.

Remark code M67 indicates a claim issue due to missing, incomplete, or invalid other procedure codes.

Remark code M69 indicates a claim was paid at the standard rate due to lack of documentation for the modified code.

Remark code M7 indicates no rental payments are due after purchase, return, or once rental equals the purchase price.

Remark code M70 indicates the NDC code was converted to a HCPCS code for claim processing, but NDC submission is still required for future claims.

Remark code M71 indicates a reduction in total payment because multiple billed tests overlap.

Remark code M73 indicates a bonus can't be paid on combined services; rebill with separate professional and technical components for eligibility.

Remark code M74 indicates a service is ineligible for Health Professional Shortage Area or Physician Scarcity bonus payments.

Remark code M75 indicates that multiple automated tests done on the same day are bundled together for billing purposes.