M135Remark Code (RARC)Active
M135 Remark Code - Missing Treatment Plan Details
The M135 remark code indicates that there is a missing, incomplete, or invalid plan of treatment associated with the claim. This remark supplements a Claim Adjustment Reason Code, providing additional detail about the specific nature of the issue regarding the treatment plan.
How It Relates to the Denial
The M135 remark typically accompanies adjustment reason codes that relate to claim denials or reductions due to insufficient documentation of the treatment plan. Together, these codes signal that the payer requires more comprehensive information regarding the patient's treatment plan to process the claim correctly.
Common Scenarios
1A physical therapy claim was submitted for multiple sessions, but the payment was reduced due to missing documentation.
→ The M135 remark suggests that the payer found the plan of treatment to be inadequate or incomplete, necessitating further clarification or documentation regarding the therapy sessions.
2A surgery claim was denied because the plan of treatment was not submitted with the initial claim.
→ In this case, the M135 remark indicates that the payer needs the full treatment plan to assess the medical necessity of the surgical procedure.
3A claim for a diagnostic test was processed with a partial adjustment, and the remittance included an M135 remark.
→ This suggests that the payer found the treatment plan to be missing key elements, which affected their decision on the claim's payment.
What to Do
- Obtain the complete plan of treatment documentation for the patient.
- Review the claim submission to ensure all necessary treatment information is included.
- Resubmit the claim with the updated plan of treatment attached.
What to Check
- The patient’s medical record for the full treatment plan.
- The original claim submission for completeness of the treatment details.
- Any communications from the payer requesting additional information about the treatment plan.