M111Remark Code (RARC)Active
M111 Remark Code - Chiropractic Treatment Denial Explanation
The M111 remark code indicates that payment for chiropractic manipulative treatment was denied because the patient refused to undergo an x-ray. This means that the payer has specific requirements regarding imaging before they will reimburse for chiropractic services.
How It Relates to the Denial
The M111 remark typically accompanies a claim adjustment reason code that signifies a denial of payment. This combination signals that the denial is specifically due to the patient's refusal to comply with the imaging requirement.
Common Scenarios
1A chiropractor submits a claim for spinal manipulation services, but the claim is denied with a reason code indicating non-payment.
→ The M111 remark clarifies that the payment was denied because the patient did not consent to have an x-ray taken, which is a prerequisite for payment.
2A physical therapy clinic bills for chiropractic manipulation, but the remittance shows a denial related to imaging requirements.
→ The presence of M111 indicates that the payer's policy requires an x-ray before payment can be made for the manipulative treatment, and since the patient refused, no payment is authorized.
3A patient receiving chiropractic care refuses to have an x-ray, leading to a denial on the submitted claim for manipulation services.
→ The M111 remark explains that the payer will not reimburse for the treatment rendered as the necessary x-ray was not completed due to the patient's refusal.
What to Do
- Verify whether the patient was informed about the x-ray requirement prior to treatment.
- Consider discussing the imaging requirement with the patient to encourage compliance for future treatments.
- If appropriate, resubmit the claim after ensuring the x-ray is completed, if the patient agrees.
What to Check
- Review the patient's consent or refusal documentation regarding the x-ray.
- Check the claim submission to ensure all necessary services and requirements were included.
- Confirm the payer's policy on chiropractic manipulative treatment and imaging requirements.