M66Remark Code (RARC)Active
M66 Remark Code - Diagnostic Tests Price Limitations
The M66 remark code indicates that the billed diagnostic tests include both a technical and professional component, but only the technical component is subject to price limitations. The payer is instructing the biller to separate these components into distinct line items for proper billing and reimbursement.
How It Relates to the Denial
The M66 remark code typically accompanies adjustment reason codes related to service pricing or reimbursement issues. This combination signals that the billed services were incorrectly submitted as a single line item when they should have been itemized into technical and professional components.
Common Scenarios
1A provider submitted a claim for a diagnostic imaging service that included both the technical and professional components as one line item.
→ The M66 remark code indicates the payer's expectation to separate the technical and professional components to comply with pricing rules.
2A claim for a lab test was billed as a single procedure code, but the remittance returned with an adjustment indicating a price limitation issue.
→ The M66 code clarifies that the lab test's components need to be billed separately, as only the technical component is eligible for the price limitation.
3An office billed an ultrasound with both components combined into one charge, resulting in a denial on the remittance advice.
→ The M66 remark code suggests that the claim needs to be resubmitted with the components itemized to align with the payer's billing requirements.
What to Do
- Separate the technical and professional components of the service into individual line items before resubmission.
- Ensure that the appropriate procedure codes are used for each component when submitting the claim.
What to Check
- Review the original claim submission to ensure it properly reflects the technical and professional components as separate items.
- Check the payer's guidelines for billing diagnostic tests to confirm the requirement for itemization.
- Verify that the procedure codes used correspond correctly to the technical and professional components of the service.