Denial code reference

All RARC (Remittance Advice Remark) codes

The complete X12-published list of Remittance Advice Remark Codes — 212 codes indexed. RARCs supplement a CARC denial reason; together they explain why a claim was reduced or denied.

Total codes indexed

212

Source

X12 / WPC

Refresh cadence

Quarterly + monthly audit

Click any code for the plain-language meaning, the category, and recommended action. RARCs are typically read alongside a CARC code — the CARC tells you the primary reason, the RARC adds detail.

Code	Category	Description
M1	Major message	X-ray not taken within the past 12 months or near enough to the start of treatment.
M10	Major message	Equipment purchases are limited to the first or the tenth month of medical necessity.
M11	Major message	DME, orthotics and prosthetics must be billed to the DME carrier who services the patient's zip code…
M115	Major message	This item is denied when provided to this patient by a non-contract or non-demonstration supplier.
M119	Major message	Missing/incomplete/invalid/deactivated/withdrawn National Drug Code (NDC).
M12	Major message	Diagnostic tests performed by a physician must indicate whether purchased services are included on t…
M124	Major message	Missing indication of whether the patient owns the equipment that requires the part or supply.
M125	Major message	Missing/incomplete/invalid information on the period of time for which the service/supply/equipment …
M127	Major message	Missing patient medical record for this service.
M129	Major message	Missing/incomplete/invalid indicator of x-ray availability for review.
M13	Major message	Only one initial visit is covered per specialty per medical group.
M132	Major message	Missing pacemaker registration form.
M133	Major message	Claim did not include patient's medical record for the service.
M14	Major message	No separate payment for an injection administered during an office visit, and no payment for a full …
M15	Major message	Separately billed services/tests have been bundled as they are considered components of the same pro…
M16	Major message	Alert: Please see our web site, mailings, or bulletins for more details concerning this policy.
M18	Major message	Certain services may be approved for home use. Neither a hospital nor a Skilled Nursing Facility (SN…
M19	Major message	Missing oxygen certification/re-certification.
M2	Major message	Not paid separately when the patient is an inpatient.
M20	Major message	Missing/incomplete/invalid HCPCS code.
M21	Major message	Missing/incomplete/invalid place of residence for the service/item provided.
M22	Major message	Missing/incomplete/invalid number of miles traveled.
M23	Major message	Missing invoice.
M24	Major message	Missing/incomplete/invalid number of doses per vial.
M25	Major message	The information furnished does not substantiate the need for this level of service.
M26	Major message	The information furnished does not substantiate the need for this level of service.
M27	Major message	Alert: The patient has been relieved of liability of payment of these items and services under the l…
M3	Major message	Equipment is the same or similar to equipment already being used.
M30	Major message	Missing pathology report.
M31	Major message	Missing radiology report.
M37	Major message	Service not covered when the patient is under age 35.
M39	Major message	Alert: The patient is not liable for payment for this service as the advance notice of non-coverage …
M4	Major message	Alert: This is the maximum reimbursement of equipment of this kind.
M44	Major message	Missing/incomplete/invalid condition code.
M45	Major message	Missing/incomplete/invalid occurrence code.
M47	Major message	Missing/incomplete/invalid Payer Claim Control Number.
M49	Major message	Missing/incomplete/invalid value code(s) or amount(s).
M5	Major message	Monthly rental payments can continue until the earliest of the 15th month from the first rental mont…
M50	Major message	Missing/incomplete/invalid revenue code(s).
M51	Major message	Missing/incomplete/invalid procedure code(s).
M52	Major message	Missing/incomplete/invalid 'from' date(s) of service.
M53	Major message	Missing/incomplete/invalid days or units of service.
M54	Major message	Missing/incomplete/invalid total charges.
M55	Major message	We do not pay for self-administered anti-emetic drugs that are not administered with a covered oral …
M56	Major message	Missing/incomplete/invalid payer identifier.
M59	Major message	Missing/incomplete/invalid 'to' date(s) of service.
M60	Major message	Missing Certificate of Medical Necessity.
M62	Major message	Missing/incomplete/invalid treatment authorization code.
M64	Major message	Missing/incomplete/invalid other diagnosis.
M67	Major message	Missing/incomplete/invalid other procedure code(s).
M69	Major message	Paid at the regular rate as you did not submit documentation to justify the modified procedure code.
M7	Major message	No rental payments after the item is purchased, or after the total of issued rental payments equals …
M70	Major message	Alert: The NDC code submitted for this service was translated to a HCPCS code for processing, but pl…
M71	Major message	Total payment reduced due to overlap of tests billed.
M75	Major message	Multiple automated multichannel tests performed on the same day combined for payment.
M76	Major message	Missing/incomplete/invalid diagnosis or condition.
M77	Major message	Missing/incomplete/invalid place of service.
M80	Major message	Not covered when performed during the same session/date as a previously processed service for the pa…
M81	Major message	You are required to code to the highest level of specificity.
M82	Major message	Service is not covered when patient is under age 50.
M86	Major message	Service denied because payment already made for same/similar procedure within set time frame.
M86	Major message	Service denied because payment already made for same/similar procedure within set time frame.
M87	Major message	Claim/service(s) subjected to CFO-CAP prepayment review.
M9	Major message	This is the tenth rental month. You must offer the option to purchase the equipment to the patient.
M97	Major message	Not paid to practitioner when provided to patient in this place of service. Payment included in the …
MA01	Medicare adjustment	Alert: If you do not agree with what we approved for these services, you may appeal our decision.
MA02	Medicare adjustment	Alert: If you do not agree with this determination, you have the right to appeal.
MA04	Medicare adjustment	Secondary payment cannot be considered without the identity of or payment information from the prima…
MA07	Medicare adjustment	Alert: The claim information has also been forwarded to Medicaid for review.
MA106	Medicare adjustment	PIP (Periodic Interim Payment) claim.
MA11	Medicare adjustment	Payment is being issued on a conditional basis.
MA120	Medicare adjustment	Missing/incomplete/invalid CLIA certification number.
MA125	Medicare adjustment	Per legislation governing this program, payment constitutes payment in full.
MA13	Medicare adjustment	Alert: You may be subject to penalties if you bill the patient for amounts not reported with the PR …
MA130	Medicare adjustment	Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because…
MA15	Medicare adjustment	Alert: Your claim has been separated to expedite handling.
MA18	Medicare adjustment	Alert: The claim information is also being forwarded to the patient's supplemental insurer.
MA31	Medicare adjustment	Missing/incomplete/invalid beginning and ending dates of the period billed.
MA32	Medicare adjustment	Missing/incomplete/invalid number of covered days during the billing period.
MA34	Medicare adjustment	Missing/incomplete/invalid number of lifetime reserve days.
MA63	Medicare adjustment	Missing/incomplete/invalid principal diagnosis.
MA66	Medicare adjustment	Missing/incomplete/invalid principal procedure code.
MA67	Medicare adjustment	Correction to a prior claim.
MA92	Medicare adjustment	Missing plan information for other insurance.
MA99	Medicare adjustment	Missing/incomplete/invalid Medigap information.
N1	Note	Alert: You may appeal this decision in writing within the required time limits following receipt of …
N109	Note	This claim/service was chosen for complex review and was denied after reviewing the medical records.
N111	Note	No appeal right except duplicate claim/service issue.
N115	Note	This decision was based on a Local Coverage Determination (LCD).
N116	Note	This payment is being made conditionally because the service was provided in the home, and it is pos…
N117	Note	This service is paid only once in a patient's lifetime.
N122	Note	Add-on code cannot be billed by itself.
N129	Note	Not eligible due to the patient's age.
N130	Note	Consult plan benefit documents/guidelines for information about restrictions for this service.
N133	Note	Services for predetermination and services requesting payment are being processed separately.
N138	Note	Alert: In the event you disagree with the Dental Advisor's opinion and have additional information r…
N146	Note	Missing screening document.
N147	Note	Long term care case mix or per diem rate cannot be determined because the patient ID number is missi…
N148	Note	Missing/incomplete/invalid date of last menstrual period.
N15	Note	Services for a newborn must be billed separately.
N156	Note	Alert: The patient is responsible for the difference between the approved treatment and the elective…
N16	Note	Family/member Out-of-Pocket maximum has been met. Payment based on a higher percentage.
N165	Note	Transportation in a vehicle other than an ambulance is not covered.
N172	Note	Patient is responsible for the difference between the higher rate and the lower rate.
N174	Note	This is not a covered service/procedure/equipment/bed.
N179	Note	Additional information has been requested from the member.
N180	Note	This item or service does not meet the criteria for the category under which it was billed.
N19	Note	Procedure code incidental to primary procedure.
N192	Note	Patient is a Medicaid/Qualified Medicare Beneficiary.
N193	Note	Specific federal/state/local program may cover this service.
N199	Note	Additional payment/recoupment approved based on payer-initiated review/audit.
N2	Note	This allowance has been made in accordance with the most appropriate course of treatment provision o…
N20	Note	Service not payable with other service rendered on the same date.
N201	Note	A mental health facility is responsible for payment of outside providers who furnish these services/…
N210	Note	Alert: You may appeal this decision.
N211	Note	Alert: You may not appeal this decision.
N22	Note	This procedure code was added/changed because it more accurately describes the services rendered.
N225	Note	Incomplete/invalid documentation/orders/notes/summary/report/chart.
N228	Note	Incomplete/invalid consent form.
N230	Note	Incomplete/invalid indication of whether the patient owns the equipment that requires the part or su…
N239	Note	Incomplete/invalid physician financial relationship form.
N24	Note	Missing/incomplete/invalid Electronic Funds Transfer (EFT) banking information.
N240	Note	Incomplete/invalid radiology report.
N245	Note	Incomplete/invalid plan information for other insurance.
N25	Note	This company has been contracted by your benefit plan to provide administrative claims payment servi…
N252	Note	Missing/incomplete/invalid attending provider primary identifier.
N256	Note	Missing/incomplete/invalid billing provider/supplier name.
N257	Note	Missing/incomplete/invalid billing provider/supplier primary identifier.
N264	Note	Missing/incomplete/invalid ordering provider name.
N265	Note	Missing/incomplete/invalid ordering provider primary identifier.
N269	Note	Missing/incomplete/invalid other provider primary identifier.
N270	Note	Missing/incomplete/invalid other provider secondary identifier.
N272	Note	Missing/incomplete/invalid other payer attending provider identifier.
N28	Note	Consent form requirements not fulfilled.
N282	Note	Missing/incomplete/invalid pay-to provider primary identifier.
N289	Note	Missing/incomplete/invalid rendering provider name.
N290	Note	Missing/incomplete/invalid rendering provider primary identifier.
N295	Note	Missing/incomplete/invalid service facility primary identifier.
N298	Note	Missing/incomplete/invalid supervising provider primary identifier.
N3	Note	Missing consent form.
N30	Note	Patient ineligible for this service.
N31	Note	Missing/incomplete/invalid prescribing provider identifier.
N32	Note	Claim must be submitted by the provider who rendered the service.
N328	Note	Missing/incomplete/invalid Home Health Certification Period.
N33	Note	No record of health check prior to initiation of treatment.
N34	Note	Incorrect claim form/format for this service.
N35	Note	Program integrity/utilization review decision.
N350	Note	Missing/incomplete/invalid description of service for a Not Otherwise Classified (NOC) code or for a…
N356	Note	Not covered when performed with, or subsequent to, a non-covered service.
N357	Note	Time frame requirements between this service/procedure/supply and a related service/procedure/supply…
N362	Note	The number of Days or Units of Service exceeds our acceptable maximum.
N370	Note	Billing exceeds the rental months covered/approved by the payer.
N381	Note	Consult our contractual agreement for restrictions/billing/payment information related to these char…
N386	Note	This decision was based on a National Coverage Determination (NCD).
N4	Note	Missing/incomplete/invalid prior treatment documentation.
N40	Note	Missing radiology film(s)/image(s).
N400	Note	Alert: Electronically enabled providers should submit claims electronically.
N418	Note	Misrouted claim. See the payer's claim submission instructions.
N423	Note	Returned for additional information.
N428	Note	Not covered when performed in this place of service.
N431	Note	Service is not covered with this procedure.
N432	Note	Adjustment based on a Recovery Audit.
N433	Note	Resubmit this claim using only your National Provider Identifier (NPI).
N434	Note	Missing/Incomplete/Invalid Present on Admission indicator.
N435	Note	Exceeds number/frequency approved/allowed within time period without support documentation.
N448	Note	This drug/service/supply is not included in the fee schedule or contracted/legislated fee arrangemen…
N448	Note	This drug/service/supply is not included in the fee schedule or contracted/legislated fee arrangemen…
N450	Note	Covered only when performed by the primary treating physician or the designee.
N461	Note	This service was made available only by negotiation between Provider and Health Plan, and shall not …
N469	Note	Alert: Claim/Service(s) subject to appeal process.
N474	Note	Missing/incomplete/invalid Federal Information Processing Standards (FIPS) Code.
N475	Note	Missing completed referral form.
N479	Note	Missing Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).
N480	Note	Incomplete/invalid Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).
N488	Note	Adjusted for failure to submit X-rays.
N489	Note	Adjusted for failure to submit narrative.
N497	Note	Service not eligible for transitional pass-through payment.
N5	Note	EOB received from previous payer. Claim not on file.
N509	Note	Alert: A current inquiry shows the Medicare Number and name do not match.
N52	Note	Patient not enrolled in the billing provider's managed care plan on the date of service.
N522	Note	Duplicate of a claim processed, or to be processed, as a crossover claim.
N525	Note	These services are not covered when performed within the global period of another service.
N54	Note	Claim information is inconsistent with pre-certified/authorized services.
N55	Note	Procedures for billing with group/referring/performing providers were not followed.
N56	Note	Procedure code billed is not correct/valid for the services billed or the date of service billed.
N566	Note	Disposition of related Property & Casualty claim is finalized.
N569	Note	Not covered when performed by this type of provider.
N57	Note	Missing/incomplete/invalid prescribing date.
N575	Note	Mismatch between the submitted ordering/referring provider name and records.
N584	Note	Not covered based on the insured's noncompliance with policy provisions.
N59	Note	Please refer to your provider manual for additional program and provider information.
N594	Note	Records indicate a partial or full HIV/AIDS exclusion exists.
N597	Note	Adjusted based on a payer's Sequestration Reduction.
N602	Note	Not covered when considered routine.
N605	Note	This service is only paid when the patient's condition is considered to be medically stable.
N613	Note	Alert: Although a Power of Attorney was submitted, the rights to appeal cannot be transferred.
N63	Note	Rebill services on separate claim lines.
N640	Note	Exceeds number/frequency approved/allowed within time period.
N65	Note	Procedure code or procedure rate count cannot be determined, or was not on file, for the date of ser…
N657	Note	This should be billed with the appropriate code for these services.
N657	Note	This should be billed with the appropriate code for these services.
N665	Note	Services by an unlicensed provider are not reimbursable.
N669	Note	If you have collected any amount from the patient, you must refund that amount to the patient within…
N674	Note	Not covered unless a pre-requisite procedure/service has been provided.
N680	Note	Missing/Incomplete/Invalid date of previous dental extractions.
N683	Note	Missing/Incomplete/Invalid prior treatment documentation.
N699	Note	Payment adjusted based on the Medical Decision Made (MDM) component of the Evaluation and Management…
N7	Note	Processing of this claim/service has included consideration under Major Medical provisions.
N70	Note	Consolidated billing and payment applies.
N75	Note	Missing/incomplete/invalid tooth surface information.
N95	Note	This provider type/provider specialty may not bill this service.
N96	Note	Patient must be refractory to conventional therapy (documented behavioral, pharmacologic and/or surg…

Sources

X12 Health Care Claim Payment/Advice (835) — Remittance Advice Remark Code list

Contact: hello@approvalhelp.com

Code